ABSTRACT
BACKGROUND: To study survival and HIV/AIDS-related mortality from 1989 through 1997. To analyze the effect of antiretroviral treatment and prophylaxis against P. carinii pneumonia (PCP-prophylaxis). PATIENTS AND METHODS: We retrospectively studied a cohort of 1,115 HIV (+) outpatients (331 with AIDS-defining criteria) seen in our specific HIV hospital unit from January 1989 through May 1997. We analyzed the effect of different antiretroviral treatments on annual mortality rate. In survival studies we used Cox regression analysis to analyze survival over time as well as the effect of different opportunistic events, adherence and changes in treatment during follow up. RESULTS: Mortality rate was 13.7 per 100 person-years in 1994. It went down to 4.2 during the first half of 1997 (p=0.001). Mortality rate decreased depending on treatment received: 53% (CI 95=34-65%) with monotherapy, 68% (CI 95=38-84%) with bitherapy, 86% (CI 95=40-96%) with triple therapy, and 49% (CI =29-64%) with PCP-prophylaxis. Patients with more than 100 CD4 had an increasing survival over time (p=0.002). In AIDS patients good adherence to antiretroviral treatment and PCP-prophylaxis were associated with a lower risk of death (RR=0.88; CI 95=0.63-1.22 and RR=0.72; CI 95=0.55-0.95 respectively). CONCLUSIONS: In recent years PCP-prophylaxis and antiretroviral treatment (especially combined therapy) have contributed to a decrease in AIDS-related mortality. Adherence to treatments relates to risk of death and survival.
Subject(s)
HIV Infections/mortality , Adolescent , Adult , Aged , Anti-Retroviral Agents/therapeutic use , Female , HIV Infections/complications , HIV Infections/drug therapy , Humans , Male , Middle Aged , Pneumocystis carinii , Pneumonia, Pneumocystis/drug therapy , Pneumonia, Pneumocystis/etiology , Pneumonia, Pneumocystis/mortality , Retrospective Studies , Survival RateABSTRACT
No disponible
Subject(s)
Adult , Male , Humans , Prevalence , Myocardial Ischemia , Prospective Studies , Pulmonary Embolism , Probability , Venous Thrombosis , Antimetabolites, Antineoplastic , Algorithms , Electrocardiography , Heart , Heart Diseases , FluorouracilSubject(s)
Paraplegia/diagnosis , Smoking/adverse effects , Biopsy , Carcinoma, Small Cell/complications , Carcinoma, Small Cell/diagnosis , Chronic Disease , Humans , Lung/pathology , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Magnetic Resonance Imaging , Male , Middle Aged , Paraplegia/etiology , Radiography, ThoracicABSTRACT
BACKGROUND: To study the efficacy and the tolerance of the zidovudine (ZDV) in monotherapy for the treatment of a cohort of patients with HIV infection, most of them injection-drug users (IDU). METHODS: Retrospective study of a historic cohort of 350 patients, from January 1988 to December 1994. The clinic progression, the immunologic deterioriation and the survival after the ZDV administration were evaluated, like the toxicity of the drug. RESULTS: The estimated progression time to AIDS for the 25% of the cohort was 29 months for the initially asymptomatic patients and 22 months for the subjects who showed symptoms. After 26 months half of the patients showed CD4 cell counts less to 50% of the basals. The cumulative survival probability after a year was 99%, 97% and 85% for the groups A, B y C of the CDC classification, and 94%, 87% and 58% after two years for these groups. The predictive factors associated with the survival were the clinic and immunologic status, ESR, LDH, and beta 2-microglobulin levels at the beginning of the treatment. The 35% of the patients suffered adverse events, mainly hematologic effects, although they only forced to suspend the treatment in the 5% of the cases. The only predictive factor associated with the toxicity was a neutrophile count less than 1.500 cells/mm3 previous to the treatment (p < 0.001). CONCLUSION: The ZDV use in monotherapy in a cohort of patients majority IDU shows the same efficacy and safety as the treatment in other patients with HIV infection.
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , Zidovudine/therapeutic use , Adult , Cohort Studies , Female , HIV Infections/immunology , Humans , Male , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
A study was conducted to know the rate of non-compliance of antituberculosis therapy among HIV-infected patients, the factors associated with non-compliance and the evolution of these patients. The therapy compliance in 276 tuberculous HIV infected patients diagnosed in two Madrid hospitals was analyzed. Fifty-one patients (18%) were not included in the analysis (6 died without therapy, 6 were lost and 39 died during therapy). Out of the 225 evaluable patients, 36 (16%, 95% CI, 11.6-21.6) did not comply with therapy. The only factor associated with a higher therapy non-compliance was the antecedent of drug use (20% of non-compliance; relative risk: 10, 95% CI, 1.4-71). Patients using drugs at tuberculosis diagnosis had higher risk for non-compliance (31%; RR, 3.1; 95% CI, 1.6-6.3). The incidence of tuberculosis reactivation after leaving therapy was 78.8/100 patient-years. Therapy non-compliance increased death risk associated with tuberculosis (RR, 9.8; 95% CI, 4.6-21). Programs for controlling antituberculous therapy should give priority to active drug users, as this is the group with the highest risk for non-compliance.
Subject(s)
HIV Infections/complications , Treatment Refusal/statistics & numerical data , Tuberculosis/drug therapy , Adult , Female , Humans , Male , Risk , Tuberculosis/complicationsABSTRACT
BACKGROUND: Disseminated infection by Mycobacterium avium-intracellulare is almost exclusively produced in individuals with HIV infection. The incidence of this infection in Spain is unknown. METHODS: The clinical and microbiologic registries of 30 patients with AIDS and disseminated infection by Mycobacterium avium are reviewed. METHODS: Twenty-three percent of the patients with AIDS had, at some time in their evolution, disseminated infection by M. avium. The clinical picture included prolonged fever, digestive symptoms, weight loss and appearance of lymph node enlargement. This infection appeared in patients with severe alteration of cellular immunity (mean CD4 lymphocytes: 0.19 x 10(9)/l). Although medium term prognosis was bad the causes of death of the patients were other opportunistic diseases related with the immunodeficiency. CONCLUSIONS: Infection by Mycobacterium avium is frequent among the population of individuals with HIV infection. With the appearance of prolonged fever in a patient with HIV infection and CD4 lymphocyte count lower than 0.2 x 10(9)/1 appropriate microbiologic studies including blood cultures for mycobacteria should be initiated.
