An evaluation of the use of the Statewide Planning and Research Cooperative System of New York State as a resource planning tool for HIV infection

Impact of protease inhibitors and other antiretroviral treatments on acquired immunodeficiency syndrome survival in San Francisco, California, 1987-1996

The authors assessed temporal trends in acquired immunodeficiency syndrome (AIDS) survival for 15,271 persons in San Francisco, California, diagnosed between 1987 and 1996 with an opportunistic illness included in the 1987 AIDS case definition. Predictors of survival were evaluated for 5,686 persons who were diagnosed between 1993 and 1996 and met the 1993 AIDS case definition. Median survival was 19 months for persons diagnosed between 1987 and 1989, 17 months for persons diagnosed between 1990 and 1992, 15 months for persons diagnosed between 1993 and 1994, and 31 months for persons diagnosed between 1995 and 1996. Decreased mortality was associated with use of antiretroviral therapy without protease inhibitors before AIDS (relative hazard (RH) = 0.88, 95% confidence interval (CI): 0.8, 1.0) and after AIDS (RH = 0.83, 95% CI: 0.7, 0.9) and use of antiretroviral agents with protease inhibitors before AIDS (RH = 0.25, 95% CI: 0.2, 0.3) and after AIDS (RH = 0.36, 95% CI: 0.3, 0.4). Increased mortality was found for persons aged > or = 40 years (RH = 1.43, 95% CI: 1.3, 1.6), persons initially diagnosed with an opportunistic illness (RH = 1.97, 95% CI: 1.8, 2.2), and homosexual injection drug users (RH = 1.33, 95% CI: 1.2, 1.5). Survival after AIDS has increased. Treatment with antiretroviral agents, particularly protease inhibitors, strongly predicts improved survival.

Patterns of hospital use by patients with diagnoses related to HIV infection

The authors analyzed the use of hospitals by patients with a diagnosis of human immunodeficiency virus (HIV) infection, using data from the National Hospital Discharge Survey. In the period 1984-90, the rates of both discharges and days of care for HIV-infected patients rose dramatically. For 1988-90, black males had the highest HIV-related discharge rate, followed by white males and black females, whose rates were similar. The discharge rate for patients with HIV-related diagnoses increased more in the Northeast than in the three other regions of the country. By 1990 the rate for the Northeast was nearly triple the rate for other major regions. More than half of female and black patients with HIV-related diagnoses were hospitalized in the Northeast. Private insurance was the principal expected source of payment for the care of half of the HIV-infected patients discharged in 1985, but for only a third in 1990. Medicaid covered 40 percent of the patients with HIV-related diagnoses discharged in 1990. Larger proportions of female than male patients and of black patients than white patients were covered by Medicaid. Acquired immunodeficiency syndrome was the diagnosis coded for most patients with an HIV-related diagnosis, but in larger proportions for patients who were male or white patients. Nonspecific HIV diagnoses were coded for larger proportions of female and black patients. HIV-infected patients had an average of 3.6 diagnoses in addition to their HIV diagnosis. Nearly a fourth of the additional diagnoses were for other infectious diseases, such as pneumocystosis or candidiasis. Anemia, pneumonia, and drug use and dependence also were frequent diagnoses.

What's in a name? The policy implications of the CDC definition of AIDS

Disease classification systems and surveillance definitions are ordinarily tools for medical professionals, not matters for political debate and patient advocacy. It is hard to imagine a protest march complaining about the classification system for colon cancer. But when it comes to AIDS, nothing is ordinary.

The Centers for Disease Control's (CDC) case definition of AIDS is used by public health officials, researchers, clinicians, hospital administrators, disability specialists, insurance administrators, health economists, legislators, social workers, policy makers, and the media. It has influenced the way the HIV epidemic is perceived, managed, and funded.

It is not surprising, then, that the CDC definition of AIDS and its proposed revision is currently the subject of intense scrutiny. The case definition has transcended epidemiology to become a symbol for the inadequacies of the U.S. government's response to the HIV epidemic, and a particular symbol for the failure to address the needs of HIV-infected women.