Survival patterns of the first 500 patients with AIDS in San Francisco

Zidovudine in asymptomatic human immunodeficiency virus infection. A controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. The AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases

Zidovudine (AZT) is a potent inhibitor of the replication of the human immunodeficiency virus (HIV), and it has been shown to improve survival in advanced HIV disease. We conducted a randomized, double-blind trial in adults with asymptomatic HIV infection who had CD4+ cell counts of fewer than 500 per cubic millimeter on entry into the study. The subjects (92 percent male) were randomly assigned to one of three treatment groups: placebo (428 subjects); zidovudine, 500 mg per day (453); or zidovudine, 1500 mg per day (457). After a mean follow-up of 55 weeks (range, 19 to 107), 33 of the subjects assigned to placebo had the acquired immunodeficiency syndrome (AIDS), as compared with 11 of those assigned to receive 500 mg of zidovudine (P = 0.002; relative risk, 2.8; 95 percent confidence interval, 1.4 to 5.6) and 14 of those assigned to receive 1500 mg of zidovudine (P = 0.05; relative risk, 1.9; 95 percent confidence interval, 1.0 to 3.5). In the three treatment groups, the rates of progression (per 100 person-years) to either AIDS or advanced AIDS-related complex were 7.6, 3.6, and 4.3, respectively. As compared with those assigned to placebo, the subjects in the zidovudine groups had significant increases in the number of CD4+ cells and significant declines in p24 antigen levels. In the 1500-mg zidovudine group, severe hematologic toxicity (anemia or neutropenia) was more frequent than in the other groups (P less than 0.0001). In the 500-mg zidovudine group, nausea was the only toxicity that was significantly more frequent (in 3.3 percent) than in the placebo group (P = 0.001). We conclude that zidovudine is safe and effective in persons with asymptomatic HIV infection and fewer than 500 CD4+ cells per cubic millimeter. Additional study will be required to determine whether such treatment will ultimately improve survival for persons infected with HIV.

Trends and patterns of opportunistic diseases in Danish AIDS patients 1980-1990

We analysed the AIDS-defining diseases in all 618 notified AIDS patients in Denmark by June 30, 1990, and looked for trends and associations over time. Pneumocystis carinii pneumonia (PCP) was the most commonly reported disease (47%), and showed some but insignificant changes over time. The number of patients reported with Kaposi's sarcoma (KS) declined significantly from 33% in 1980-84 to 12% in 1990. KS was reported 5 times as often in homosexual men as in all other AIDS patients while esophageal candidiasis was reported in one fifth of the patients and were reported twice as often in women as in homosexual men. Wasting and HIV encephalopathy were 2.5 times more often reported in women than in homosexual men. The overall survival rate was 56% (95% confidence interval: 51-61%) at 1 year and 21% (95% confidence interval: 15-28%) at 3 years. Significantly improved survival over time was observed in patients diagnosed with PCP. Patients reported with KS had a significantly better prognosis than those with PCP. Women in general had a bad prognosis.

A survival analysis of hospitalization among patients with acquired immunodeficiency syndrome

Survival analysis techniques were used in estimating lifetime inpatient utilization among patients diagnosed with acquired immunodeficiency syndrome (AIDS) using data on 863 members of the Kaiser Permanente Medical Care Program in the Northern California Region diagnosed with AIDS between January 1, 1981 and June 30, 1987. Using information on both deceased and living patients, we estimated means of 40.3 lifetime inpatient days and 3.3 hospitalizations among all AIDS patients. Those presenting with Kaposi's sarcoma experienced a mean of 7.6 fewer lifetime inpatient days than those presenting with Pneumocystis carinii pneumonia (95% confidence interval = .61, 14.6) and a mean of 11.0 (3.9, 18.6) fewer inpatient days than all other AIDS patients. Older patients had fewer hospital admissions than younger ones. Year of diagnosis does not appear to be related to lifetime utilization, and there is an indication that increased survival has been accompanied by decreased inpatient utilization intensity as measured on a per person-year basis. We recommend the use of survival analysis methods in the study of utilization among groups of patients with incomplete follow-up.

AIDS cost modeling in the U.S.: a pragmatic approach

Sophisticated modeling of the economic impact of AIDS remains a future goal rather than a present reality due to a lack of data. However, policy makers with responsibility for implementing AIDS-related programs have an immediate need for estimates of service utilization and costs. In this paper we describe a microcomputer-based planning model which is structured to reflect the 'epidemic of epidemics' nature of AIDS. In the process of constructing this model, deficiencies in existing data sources have become evident. The second part of the paper describes research issues and priorities for improving data used to estimate the cost of AIDS.