High Exposure

Fighting an epidemic often means choosing between the public's need for protection and a patient's right to privacy. Faced with the still spreading menace of AIDS, Government officials last week proposed the most far-reaching measures yet to control the incurable disease, recommending that millions of Americans in high-risk groups voluntarily undergo periodic blood tests to determine whether they have been exposed to the HLTV-3, or LAV, virus. At the same time, health authorities stressed the need to ensure confidentiality.

The number of AIDS victims remains relatively low--some 18,070 cases have been reported to date, including 9,591 deaths. But authorities estimate that as many as a million Americans may be carrying the AIDS virus and exposing others to infection: indeed, they say, AIDS is spread primarily by carriers who are not ill. The Public Health Service defines high-risk groups as homosexual men, intravenous drug abusers, prostitutes, the sex partners of infected individuals, and hemophiliacs who receive blood-clotting products. Also designated high risk were natives of Haiti and the Central Africa nations, where heterosexual transmission of AIDS is believed to be more widespread than in the U.S.

The AIDS-screening test, which detects antibodies to the virus in the blood, is already being given to all 2.3 million U.S. service members, and has been used to safeguard the nation's blood supply. Civil libertarians are concerned about the possible misuse of test results to discriminate against homosexuals. Dr. Walter R. Dowdie, the AIDS coordinator for the Public Health Service, emphasized the "crucial need to ensure confidentiality for high-risk persons and to protect their medical records from unauthorized disclosure."

Meanwhile, AIDS sufferers received some encouraging news last week in a study published in the Lancet, a British medical journal. Doctors at the National Cancer Institute and Duke University reported that an experimental anti-AIDS drug, azidothymidine, or AZT, improved the immune system of 15 of the first 19 patients to receive it, producing at least a temporary respite from their condition.

The patients, who experienced fewer fevers and infections, as well as weight gain and greater appetite, benefited from increases in the number of the immune system's vital white blood cells known as helper-inducer T cells, which are killed by the AIDS virus. Most significant, said Dr. Robert Yarchoan of the National Cancer Institute, the study shows that when the deadly virus is blocked, "the immune system of an AIDS patient can at least partially reconstitute itself.