COSTLY DRUGS, SURGE IN PATIENTS STRAINING STATE AIDS PROGRAMS.

Byline: Lauran Neergaard Associated Press 

State after state is running low on money to buy the newest, most potent AIDS drugs for thousands of low-income Americans, leaving many patients facing a possible rationing of medicine.

Washington last month became the latest state, following Illinois and Kansas, to dramatically cut its AIDS Drug Assistance Program as it tried to avert almost certain bankruptcy.

More cutbacks are pending as states scramble to cover unexpected bills for new patients, not counting the thousands suddenly demanding treatment because of headlines promising unprecedented new hope for AIDS.

And as many as 20 states haven't begun offering the newest drugs as they grapple with the costs.

``For all the folks drowning in the sea of HIV disease, all of a sudden there's a lifeboat . . . and when they swim to it, it's full,'' said Washington AIDS Director Mariella Cummings, who temporarily shut that state's AIDS drug program after a 76 percent jump in AIDS patients between January and June pushed her bills from $53,000 a month to $144,000.

``That's the image I wake up with and go to sleep with,'' she said. ``How we are going to get some more lifeboats in the water?''

At issue are state AIDS Drug Assistance Programs, or ADAPs, that buy medicine for uninsured HIV-infected people who don't qualify for Medicaid because they're not quite poor enough or sick enough.

This fiscal year, ADAPs will spend $145 million buying drugs for 65,000 Americans. That includes an extra $52 million in emergency funds President Clinton allotted this spring in anticipation of the crisis, money many states say is all that's keeping them afloat.

ADAPs are in trouble mainly because of new drugs called protease inhibitors that, when combined with two older drugs, are so potent that AIDS patients have their first hope of truly longer and healthier lives.

But these three-drug cocktails cost $10,000 to $15,000 per person per year. That doesn't count the myriad other drugs taken to fight pneumonia and other deadly illnesses that stalk AIDS patients.

And proteases have a unique problem: To stop taking them for even a month because the ADAP temporarily ran out of money can allow HIV to rapidly mutate into a virtually untreatable strain.

When protease inhibitors began selling in December, ADAPs faced a triple threat: How to afford at least one and give it to only the patients as they could guarantee a constant supply - even as patients who had shunned treatment until the proteases made headlines this spring suddenly started lining at their doors.

Twenty-nine states now offer at least one protease, and 21 offer all three, according to the National Alliance of State and Territorial AIDS Directors.