HIV-Infected Advised to Return to the Basics : Health: New thinking in slowing the onset of AIDS includes such fundamentals as exercise, stress management, vitamin supplements--and the drug AZT.

Vittorio, 25, has never been in better shape. He exercises regularly, eats well, takes vitamin supplements and meditates to relieve stress. He looks trim and rested, but looks are not what this is about.

Infected with the AIDS virus for more than a year, Vittorio is fighting for his life. The vitamins and strengthening lifestyle are aimed at bolstering his immune system against the assault of the human immunodeficiency virus (HIV). Vittorio also takes low doses of the antiviral drug AZT to put off the deadly infections that mark a person’s transition from asymptomatic HIV infection to AIDS.

His efforts reflect the latest thinking on treatment of HIV infection. The lifestyle changes incorporate health preservative lessons of other illnesses, such as heart disease whose sufferers are urged to quit smoking and exercise moderately to strengthen heart muscle. The other part of Vittorio’s regimen, AZT, was approved for asymptomatic HIV infection by the U.S. Food and Drug Administration last March in response to studies showing the drug effective in delaying the onset of AIDS.

In the months since, health officials and clinic administrators in Southern California have seen new interest in testing for HIV infection. Among those asking for tests are people who previously shunned knowledge of their HIV status in the belief they could do nothing about a positive test result but wait to get sick. Of those who test positive, some, like Vittorio, are embracing early treatment and reporting continued good health.

That’s the good news.

The bad news is that many people who could benefit from early drug treatment will not get it because they, along with the public health system, lack money. In particular, high-risk minorities and their sexual partners--who are frequently uninsured--are underrepresented in treatment, even as the epidemic worsens in their communities.

And public clinics are so full that they often cannot take early on cases of HIV infection because they have to give priority to sicker patients.

“We would love to take more patients, but we desperately need funding,” said Janet Costantinou, director of the Beach Area Family Health Center in San Diego. A majority of the center’s AIDS and HIV patients lack health insurance.

If everybody who qualified for early HIV treatment could get it, federal health officials have estimated that the expanded guidelines for AZT use could apply to as many as 600,000 of the estimated 1 million HIV-infected people in the United States.

One place where they are showing up is the Valley Community Clinic in North Hollywood, a testing site funded by the Los Angeles County Department of Public Health. Administrator Diane Chamberlain says the volume of people seeking HIV testing has grown over the last four months, a trend she attributes to the FDA action on AZT.

The clinic is also getting the word out about the advantages of early testing and medical intervention, helped by a $12,000 advertising grant from the manufacturer of AZT, Burroughs Wellcome Co. “Living with HIV: The sooner you take control, the better,” read a recent ad in the newspaper, LA Weekly.

Getting the word out, however, has been an uneven effort. Homosexual, white men, especially those with private health insurance and close ties to the gay community, tend to be the most informed. People at risk in poor minority communities and the uncounted numbers of infected drug abusers appear least aware, health officials and AIDS activists say.

David Johnson, AIDS program coordinator for the city of Los Angeles, points to Los Angeles County statistics that show the number of AIDS cases rising among blacks, Latinos and Asians in low-income neighborhoods. Recent cuts in the county health budget have made it even more difficult for residents of these neighborhoods--medically underserved for years--to obtain health care.

“We have a drug that can help people stay healthy longer, that can prevent the development of AIDS and (county health officials) aren’t even telling these communities about that option,” Johnson charged.

Robert Frangenberg, director of the county AIDS program, agrees that AIDS preventive services for people without health insurance are limited. The outpatient clinics of the county’s six public hospitals are so crowded that the largest one, County-USC Medical Center, has largely had to abandon preventive HIV treatment in order to deal with those already sick with AIDS, Frangenberg said. Even under these criteria, the average waiting time for a first appointment is 21 weeks, according to hospital administrators.

The only openings are in a special County-USC program for HIV-infected children and their parents, according to its director, Dr. Andrea Kovacs. But for adults to be seen and receive preventive HIV treatment, they must have an infected child.

The situation in other Southern California counties is similarly bittersweet: more people aware of the benefits of early testing and treatment are looking to enroll in programs with few vacancies and no money to expand.

In San Diego County, the Owen Clinic at UC San Diego, is “maxed out,” accepting new HIV-infected patients only when other patients leave, according to Sherry Smith, a university spokeswoman. Other outpatient HIV programs also are nearly filled, county officials said.

In Orange County, public health services for HIV-infected residents are “about at the breaking point,” said Dr. Penny Weismuller, the county’s manager for disease control. The only public clinic for HIV treatment, located at health department headquarters in Santa Ana, now follows about 1,500 patients.

“AIDS just intensifies the financial difficulties in health care access,” Weismuller said.

Some relief may be coming from Washington. Congress this year approved the Ryan White Care Act, which sets up an emergency fund for 16 cities or jurisdictions hardest hit by the AIDS epidemic. Eligible jurisdictions in California are Los Angeles, San Francisco and San Diego counties.

Elated by its passage, proponents now worry that the care act will lose out in the appropriations phase, unable to compete with the Middle East crisis, the federal deficit and a looming recession. But if the program is funded, Los Angeles County, for one, plans to use the money to expand services for early HIV treatment. Outpatient clinics would be opened at the county’s five comprehensive health care centers, Frangenberg said.

Meanwhile, the private AIDS Healthcare Foundation in Los Angeles, which already operates a hospice for AIDS patients, is preparing to open a clinic next month in northeast Los Angeles exclusively for the treatment of early HIV infection. Patients at the clinic will be accepted regardless of their ability to pay, said Michael Weinstein, president of the foundation. But he added that the need in Los Angeles is far greater than the clinic will be able to serve.

Vittorio is luckier than many. He is extraordinarily well-informed about treatment of HIV, having spent years teaching others about the virus as a counselor at the Gay and Lesbian Community Services Center in Hollywood. He also has private insurance, and thus faced few financial barriers to early treatment with AZT. At its lowest dose, the drug still costs about $2,200 a year per patient.

Still, Vittorio did not immediately seek care when his HIV test came back positive. He was as shaken as anyone else by the news, and says he spent several months trying to regain his balance.

“There was a lot of fear, a lot of hopelessness,” he recalled. “You start thinking about how much time you have left, about your future. A lot of anger comes up at everything. You have a sense of feeling cheated.”

But getting on AZT and changing to a more healthful lifestyle, Vittorio says, has helped sort out the chaos of his emotions as much as it seems to have kept up his T4 cell count--critical components of the human immune system that are HIV’s main targets.

“A year and three months later, here I am, still around, with a life to lead,” he said.