Costs of terminal care for people with AIDS.

Despite the numerous studies on the costs of AIDS, little has been reported on the economic costs for terminal care. This study reports on the average monthly costs of care used in the last 6 months of life by a group of people with AIDS between 1984 and 1990. Hospital and outpatient visits, laboratory results, and medications were evaluated for all subjects. Standard costs (1990 dollars) were applied to all services. The 81 subjects received care in a large private medical practice located in northern California. The group was primarily male (98 percent), white (87 percent), and gay or bisexual (89 percent). Mean age at diagnosis of AIDS was 40.8 (SE = 1.1). Patients averaged a total of 2.9 (SE = 0.2) opportunistic infections (OIs) from the diagnosis of AIDS to death. Median survival was 13.2 months. The primary outcome measures were the components of the costs of terminal care: inpatient visits and outpatient costs. Covariates include location of death, year of death, and OIs. Average monthly terminal care resources included 8.3 days of in-hospital care, $8258 in costs for inpatients care, $840 in outpatient costs, and $9098 in total costs. Death at home increased in frequency (from 20 percent for 1984-1987 to 37 percent for 1987-1990). However, costs in the last 6 months of life did not change significantly as costs for patients who died in the hospital decreased and costs for patients who died at home increased over time. Policies that promote dying at home, while likely to affect patient quality of life, may not lower health care costs.

Zidovudine susceptibility testing of human immunodeficiency virus type 1 (HIV) clinical isolates.

Traditional antiviral susceptibility testing methods using cell lines can be applied to no more than about 30% of clinical HIV isolates (Larder et al., 1989a; Fenyo et al., 1989). We tested the cell-free supernatant from low passage clinical HIV isolates using donor peripheral blood mononuclear cells (PBMC). Drug susceptibility was assessed by measuring the effect of increasing zidovudine (ZDV) concentrations on HIV P24 antigen production. Susceptibility results were obtained on 24/27 consecutive clinical isolates and 6/6 laboratory isolates. The mean IC90 of isolates from untreated patients was 0.008 microM ZDV (range: 0.002-0.038). The IC90s of isolates from ZDV-treated patients ranged from 0.007 to greater than 10 microM ZDV. All isolates with an IC90 < 0.1 microM ZDV had a wild type sequence at codon 215 of the HIV pol gene; 11/12 isolates with an IC90 > 0.1 microM ZDV had a mutation at codon 215 (P < 0.001). Among 16 ZDV-treated patients, there was a modest correlation between the change in CD4 count from the start of ZDV treatment and the IC90 of the patient's isolate following treatment (r = 0.51). Susceptibility testing using donor PBMC can be a sensitive means of testing a broad range of clinical HIV isolates.