Reports on HIV/AIDS: 1990

NOVEMBER 30, 1990, MMWR, Vol. 39, RR-16 [inclusive page numbers]
supplemental data through AIDS and HIV surveillance on social/economic
status, drug use, sex behaviors, access to health services, and, for women,
reproductive history. This will fulfill recommendation 3.
EFFECT OF THERAPY ON DISEASE PROGRESSION
This group was asked to estimate the impact of AIDS therapy on past and future
incidence of AIDS. Getting that estimate required assessing the magnitude of the
treatment impact and the prevalence of persons taking AIDS therapies (specifically,
zidovudine and prophylactic therapy for P. carinii pneumonia), both currently and in
1987 when there was a decline in the rate of increase in numbers of diagnosed AIDS
cases reported to CDC.
Data presented at the workshop indicated that the use of zidovudine initially
reduces the risk of developing AIDS for some HIV-infected persons who are asymptomatic or mildly symptomatic but who have CD4+ cell counts of <500/mm3. Current
data indicate that, in a clinical trial setting, the risk of progression to AIDS among
treated patients is approximately one-third the risk for untreated patients (27).
Although the use of zidovudine delays the onset of AIDS only temporarily, the
therapeutic benefit may be extended by new types of therapy currently being
evaluated.
The group's opinion was that access to AIDS/HIV drugs differs among population
groups. Some groups-such as homosexual men on the East and West Coasts-have
greater access, whereas other groups-such as minority persons and IVDUs not in
treatment programs-have much lower access. Data from the San Francisco City
Clinic Study (conducted by the San Francisco Health Department and CDC) show that
73% of homosexual men who would most likely benefit from therapy (i.e., men who
knew they were HIV-seropositive and who had CD4+ cell counts of <200 cells/mm3)
were taking zidovudine in 1989 (28). No data were available to indicate the percentage of HIV-infected persons among low-access groups receiving zidovudine or other
appropriate therapies.
Although the number of pediatric cases is comparatively small, members of the
group thought that previous modeling exercises had not addressed differences in
prognosis and therapies among children compared with others. Limited data suggest
that symptomatic children who take zidovudine have favorable outcomes that are
comparable to those for adults who take zidovudine. For example, a 2- to 3-fold
reduction in deaths was observed among 20 children in a Phase I study of zidovudine.
The proportion of children diagnosed as having HIV infection who are being treated
with zidovudine is not known but probably does not exceed 50%. HIV-infected
children are still a comparatively low-access group.
Data available at the workshop were insufficient to estimate the relative contribution of therapeutic interventions such as zidovudine or prophylactic therapy for P.
carinii pneumonia to the slowing in the rate of increase among reported AIDS cases
that occurred in the middle of 1987. Although therapy could substantially reduce the
development of AIDS in the short term, there were few data available to the working
group to indicate that zidovudine and prophylactic therapy for P. carinii pneumonia
were widely used in 1987 by persons who had not yet developed AIDS, even among
high-access groups. The group estimated that approximately 7% of HIV-seropositive,

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