Costos de atención de pacientes seropositivos VIH y SIDA en cuatro hospitales de Santiago de Chile / Medical care costs for HIV positive and AIDS patients in four hospitals in Santiago

Background: Medical care of HIV infected and AIDS patients may represent an important economical burden for public hospitals. Aim: To assess direct and indirect costs of medical care for HIV infected and AIDS patients in public hospitals of the Metropolitan Region of Chile. Material and methods: Between August 1994 and February 1995, information about outpatient and hospitalized medical care of 417 HIV infected patients was gathered (representing approximately 16 percent of the seropositive population). Patients were divided as having or not having AIDS. The latter were those included in groups I, II, III and category C2 of group C (group 4). The cost of medications, procedures and examinations of these patients was calculated. Results: Thirty six percent of studied patients had AIDS. The annual cost of care for AIDS patients was US$3760 compared to US$1450 for HIV infected patients without AIDS. Medication represented 75 percent and 65 percent of total costs in patients with and without AIDS respectively. The figures for examination and procedures were 17 percent and 22 percent and for medical attentions were 7.5 percent and 8.8 percent respectively. Conclusions: Medical care of patients with AIDS has higher costs than that of HIV infected patients without AIDS. Thus, the retardation of the progression of the disease would have social, humanitarian and economical benefits. Our costs are similar to those of other countries with a similar level of economic development

Historia natural de la infección por virus de inmunodeficiencia humano en una cohorte de pacientes chilenos / Natural history of human immunodeficiency virus infection in a cohort of chilean patients

We characterized clinical manifestations and the risk to develop AIDS in a cohort of 32 patients infected with human immunodeficiency virus without AIDS. A multivariate analysis was performed to determine association between the progression of infection and control variables (socioeconomic level, age, sex and sexual preferences) and causal variables (psychosocial changes, significant clinical events, stress scoring and sexual activity). The cumulative AIDS incidence, defined as CD4 lymphocyte count below 200 cells/cmü was 50 percent at 6.5 years and 82 percent at 8 years. Using clinical criteria to define AIDS, 50 percent developed tha disease at 8 years of follow up. Among studied factors, only age (faster progression at higher age) and time of evolution were associated with progression. In stages before AIDS, the most frequent diseases were acute diarrhea, sexual transmission diseases, oral candidiasis, sinusitis and varicella zoster infections. The reduction of CD4 lymphocytes below 200 cells/cmü always preceded the symptoms of the disease. Two patients have remained more than eight years without clinical or immunological deterioration

Efectividad de la vacuna antisarampión en el terreno: un estudio de casos y controles / Case control study on measles vaccine effectiveness

Amplias controversias han surgido en torno a la utilidad de la vacuna sarampión usada en nuestro país a raíz de los sucesivos brotes epidémico de esta enfermedad. La última de estas epidemias motivó al estudio de casos y controles, cuyo objetivo fue determinar en terreno la efectividad de la vacuna antisarampión aplicada al año de edad. Los casos notificados fueron recopilados en el Departamento Programa de las Personas del Servicio de Salud Metropolitano Oriente y los controles pareados por edad seleccionados en el vecindario. Se verificó la condición de casos de sarampión o de control sano a través de anamnesis y calificación del cuadro clínico, y la vacunación se certificó mediante el carnet de control de salud o registro de los consultorios correspondientes. Se encontró que 96% de los controles habían sido vacunados comparados con sólo 71% de los enfermos (p=0,002). Se calculó una efectividad entre 90 y 100% dependiendo del método de análisis, no pareado y pareado respectivamente. Se concluye que la vacuna antisarampión aplicada al año de vida sigue siendo una herramienta útil en el control del sarampión y que la existencia de epidemias se explica, en gran parte, por baja cobertura