AZT Can Keep the Ill Productive, but Not if Federal Funds Dry Up

The definition of AIDS prevention is changing. In the past it referred only to efforts to slow the spread of the human immunodeficiency virus (HIV). Now, however, it also means slowing the progression of disease in people who are already infected with the virus. Like so many other parts of the epidemic, this, too, will be expensive. As recent experience with the drug AZT has shown, government has not yet made the decision that it must play a major role in prolonging quality life for many people who are ill in their most productive years.

Treatment to prevent AIDS in those who are already infected will involve at least three types of drugs: those (like AZT) that suppress the virus, others that will boost the immune system and those that prevent infections occurring in people with a severely compromised immune system. Hundreds of millions or even billions of dollars will be spent over the next several years on research to develop all three types of medication. Once they are developed, it is likely that patients will need all three for the rest of their lives.

If current assumptions are correct that most people who are infected will eventually develop a severely depressed immune system, then society will need to provide medications eventually to a million or more Americans. This need will be particularly critical because no other life-threatening disease affects so many people in their 20s, 30s and 40s.

The example of AZT, which is the only drug approved by the Food and Drug Administration as effective in prolonging life and relieving symptoms, demonstrates government’s difficulty in grappling with the cost of AIDS drugs. President Reagan signed a one-time appropriation of $30 million in 1987 to subsidize the costs of AZT for people who could not afford it. The program applies to people who make too much money to be on Medicaid or MediCal and who do not have health insurance that pays for the drug. It was made clear that this was a stopgap measure that would end Sept. 30, 1988.

However, since the bill was signed, neither Congress nor the states have made provisions to continue AZT for the 5,800 people nationwide who are receiving the drugs from this program. No provision has been made for the thousands more who will need it in the next year and the year after, although AZT will continue to be available for those who are eligible for Medicaid or Medi-Cal. Both the states and the federal government appear to be waiting for the other to provide a long-term solution. It is likely to be far too expensive for the states to do more than provide a short extension of the current program. Long-term solutions must lie with the federal government.

Although the cost of AZT has been reduced in the past year, the cost at a typical pharmacy is still about $2.30 per pill, or about $10,000 per year per person. One drug that is being used to replace half the dose of AZT turns out to be just as expensive.

Since AZT prolongs life and helps people feel better, it might be considered the equivalent of insulin for diabetics. A better analogy would be to equate AIDS drugs with dialysis machines for people with kidney failure. In the 1970s the federal government recognized that chronic hemodialysis, which cost about $25,000 per year, was too expensive for most Americans. Thus it was decided to cover dialysis costs under Medicare--even for people with health insurance that would have paid for it. A similar decision for AIDS must be made because the problem of AZT is likely to be repeated and magnified as newer and better (and possibly more expensive) drugs become available.

It is widely recognized that no cure for AIDS is likely in this century. Nor is a vaccine likely to help those who are already infected. Thus AIDS, or more probably HIV infection, will need to be seen as a chronic, expensive disease. People with health insurance and coverage for drugs will be provided for, as will those who are or who will become impoverished. However, an estimated 37 million Americans have no health insurance, and millions of others have no drug coverage to make the cost of AIDS medications affordable should they become ill.

Thus we must solve two urgent problems: continuing the AZT program for those who are already enrolled and for the additional patients who will need it. Equally important is the need for a long-term solution, which will require federal government funding. Like the epidemic, the problem will not just go away.

If government does not accept this responsibility in funding AIDS drugs, we will be left with the availability of medication to keep people feeling well enough to work; the only way in which many will be able to obtain that medication would be to stop work, go on disability and become impoverished.