COMBINATION THERAPY FOR HIV - THE EFFECT ON INPATIENT ACTIVITY, MORBIDITY AND MORTALITY OF A COHORT OF PATIENTS

We set out to quantify the changes in HIV-related morbidity and mortal ity associated with the clinical use of antiretroviral therapy via pro spectively collected patient-related events (admissions, bed days, dea ths, WHO stage 3 and 4 events and drug costs) on all HIV patients know n to the Regional Infectious Disease Unit (RIDU) from 1 January 1987 t o 31 December 1996. The introduction of zidovudine monotherapy in 1987 for those with AIDS was associated with a subsequent decline of inpat ient activity for 2 years: in 1989 there was a 23% reduction in bed da ys but only a 6% reduction in admissions. A further dramatic decline o f patient-related events in those with AIDS was-noted during 1996 foll owing the introduction of combination therapy, a 39% reduction in admi ssions, 44% reduction in bed days, 54% reduction in stage 4 events, 33 % reduction in WHO stage 3 events and 40% reduction in the death rate. Reductions were also observed for patients without AIDS including a 4 2% reduction in the rate of patients developing AIDS. Similar reductio ns were noted when the patients were classified by immunological inste ad of clinical status although data for 1997 suggest an increase in pa tient-related activity for those with CD4 counts >200 cells/ul possibl y as a result of low levels of anti-HIV therapy. The introduction of c ombination therapy for HIV has to date led to a minimum saving of one inpatient bed per 100 patient years which helped defray the cost of co mbination therapy. Although we cannot imply causality from an observat ional study, dramatic reductions in patient-related activity were asso ciated with the introduction of combination therapy into clinical prac tice. The ultimate extent and duration of this effect cannot as yet be predicted and caution is required since similar reductions were noted with zidovudine therapy which were unfortunately time limited.