SURVIVAL AND TREATMENT OF AIDS PATIENTS 1984-1993 - EXPERIENCE OF A SMALLER EAST LONDON HIV CENTER

Objective: To assess changes in survival from diagnosis of AIDS for pa tients managed in a small East London HIV clinic and the impact of the rapeutic interventions on these survival patterns. Design: Prospective observational study. Setting: Grahame Hayton Unit, Royal London Hospi tal. Subjects: 156 AIDS patients managed between 1984 and 1993. Main o utcome measure: Survival from diagnosis of AIDS. Results: Median survi val for those diagnosed with AIDS before 1 January 1987 was 9.4 months compared with 27.2 months after 1 January 1987 (logrank chi(2) = 10.3 , p = 0.001): CD4 count at time of AIDS and treatment with zidovudine or PCP prophylaxis were significantly associated with survival from ti me of AIDS. Of the 156 AIDS patients, 93 had been treated with zidovud ine sometime during their follow up, 60 had received primary and 50 se condary Pneumocystis carinii pneumonia (PCP) prophylaxis. After contro lling for gender, sexual orientation, age at time of AIDS, CD4 count a t time of AIDS, diagnosis when first presenting to the clinic (AIDS/no n-AIDS) and year of AIDS diagnosis, all patients who received either z idovudine or FCP prophylaxis had significant reductions in the risk of dying compared with those who received neither PCP prophylaxis nor zi dovudine: a reduction in risk of dying between 71% (95%CI 40% to 86%) and 83% (95%CI 50% to 94%) was observed depending on the combination o f zidovudine and PCP prophylaxis. Conclusion: A debate is currently ta king place about the format and value of HIV service provision with in creasing numbers of HIV infected individuals managed at smaller HIV cl inics. Larger clinics concentrate clinical expertise on a single site and facilitate clinical trials. Smaller well run HIV units staffed by competent health professionals not only provide clinical outcomes simi lar to those obtained in the larger centres, but may also allow a more informal and intimate setting for HIV infected individuals who want t o be heated nearer their area of residence.