... and applying them to public policy.

... and applying them to public policy

AIDS epidemiologic studies have as their mission more than a simple tally of deaths. By documenting specific physiological changes in HIV-infected individuals as they progress to AIDS, the studies can help reveal the telltale signs of decline. Researchers want to use that information to decide when to start prophylactic drugs -- some of which are too toxic or too expensive to take before they're really needed but may be ineffective if given too late.

Marking one of the first practical applications of such data, U.S. Assistant Secretary for Health James O. Mason last week announced new federal recommendations stating that some asymptomatic, HIV-infected people should not want until they have symptoms of Pneumocystis carinii pneumonia before beginning treatment with aerosolized pentamidine -- a drug that helps prevent the disease. P. carinnii is the major cause of death among people with AIDS.

The Centers for Disease Control in Atlanta will publish the new recommendations within the next few weeks, Mason says. The policy will apply to HIV-infected people having fewer than 200 CD4 cells (a kind of white blood cell) per cubic millimeter of blood. Studies indicate that P. carinii pneumonia is often preceded by low CD4 counts and that early administration of pentamidine, given as an aerosol inhalant, can delay its onset for years.

Aerosolized pentamidine has been widely available since February through a special federal program that offers promising new drugs to patients with proven needs. Without the federal endorsement that now appears imminent, however, insurers have not been obligated to pay for the drug.

How the government or insurers will foot the bill, however, remains unclear. Monthly doses of pentamidine cost more than $100; CD4 tests can cost even more. Tens of thousands of individuals may be eligible for the drug.