FREQUENCIES OF OPPORTUNISTIC DISEASES PRIOR TO DEATH AMONG HIV-INFECTED PERSONS

Objectives: To describe the complete history of major opportunistic ev ents experienced by 1883 HIV-infected persons prior to and specificall y within 6 months of death, and to determine whether the frequency of specific events varies according to demographic characteristics, risk behaviors or geographic location. Design: Descriptive case series. Met hods: Of 6682 HIV-infected individuals enrolled in studies sponsored b y the Community Programs for Clinical Research on AIDS between Septemb er 1990 and lune 1994, 1883 died during follow-up. A complete history of AIDS-defining events was determined for these patients by combining medical history data obtained at the time of enrollment, new events t hat occurred during follow-up, and causes of death. Results: The most common opportunistic AIDS-defining events these 1883 patients experien ced before death were Pneumocystis carinii pneumonia (PCP; 45%), Mycob acterium avium complex (MAC; 25%), wasting syndrome (25%), bacterial p neumonia (24%), cytomegalovirus (CMV) disease (23%) and candidiasis (e sophageal or pulmonary; 22%). in addition, 47% of patients experienced two or three AIDS-defining events before death, and 22% experienced f our or more events. In the 6 months prior to death, 22% of patients ha d PCP, 21% had MAC, and 20% had CMV disease. Significant sex and ethni c differences were found: bacterial pneumonia occurred more often befo re death in women compared with men; fewer blacks and Latinos than whi tes experienced Kaposi's sarcoma (KS); and fewer blacks than whites ha d CMV disease before death. The percentage of patients with KS and CMV also varied by risk behavior. The frequency of 10 opportunistic disea ses varied by geographic region after adjustment for demographic chara cteristics and risk behavior. Of note, many more patients in northeast ern USA had tuberculosis and fewer had MAC. Conclusion: A large percen tage of individuals with HIV infection experienced multiple AIDS-defin ing opportunistic diseases before death. PCP, MAC, wasting syndrome, b acterial pneumonia, CMV disease, and candidiasis (esophageal or pulmon ary) account for a substantial proportion of morbidity associated with HIV infection. More diseases varied by geographic location than by de mographic characteristics or risk behavior of patients. Continued rese arch on the etiology and prevention of these diseases and how they rel ate to one another should be a high priority.