Clinical manifestations and survival trends during the first 12 years of the AIDS epidemic in Mexico

Background Our objective was to evaluate survival trends (1984-1995), the p revalence of AIDS-defining conditions, and the role of treatment with zidov udine and/or prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) in su rvival following AIDS diagnosis. Methods. We reviewed the clinical charts and postmortem studies of all pati ents admitted to the HIV Clinic from 1984-1995. Three groups were identifie d according to the following dates of HIV diagnosis: 1) 1984-1988; 2) 1989- 1992, and 3) 1993-1995. Results. We studied 909 charts. During the study period, 744 (81.6%) patien ts developed AIDS. Median survival increased from 11.7 months in group 1 to 15.4 and 17.5 months in groups 2 and 3, respectively (p <0.05). We observe d the following important changes in the frequency of AIDS-defining conditi ons over the study period: Pneumocystis carinii pneumonia (PCP) decreased f rom 24.8 to 17 and 14% in groups 1, 2, and 3, respectively, (p = 0.008), an d Kaposi's sarcoma (KS), from 31.1 to 10.5 and 13.5% (p <0.001). On the oth er hand, there was an increase in cytomegalovirus disease with 12.4, 20.4, and 18.6% (p = 0.04) and wasting syndrome with 36, 45, and 57% (p <0.001). In the proportional hazard model for death, zidovudine or TMP-SMX use was a ssociated with a protective effect. Conclusions. Survival is improving among patients with HN infection at our institution. The prevalence of AIDS-defining conditions has changed over th e last 12 years. There has been a diminution of PCP and KS, whereas cases o f CMV disease and wasting syndrome increased. <(c)> 2001 IMSS. Published by Elsevier Science Inc.