Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Tu.B.2153 -Tu.B.2158

Tuesday July 9, 1996

Results: (020 patients (65%) received at least one ARV drug at the time of the study ARV
thnr.)/ s moro frequent ly used amrong patients from south and central Europe as compaci l it;r o rn or-th E urope (72%, 70% and 54%, respectively p<0.0001), espe
tolly pnirgtent wit (1)4 ount 200 (iOf patients on ARV therapy, 34% received
opr Itbl r r rtn thrifapy. Combntion therapy as opposed to monotherapy was
ir n ir t lr I ir r tii irp, i al Europe compared with other regions (27%, 50% and 3 I,
rep'pr,p t001.These dfirene were also found in multivariate logistic regression
ciod,, Iicictr dr-ug i n" were lss ikely to recieve ARV therapy compared with homo
scxu, rcr o n de di fferences in use of ARV's were detected Primary PCP prophylaxis
wts ised by 85% of patienrt with i CD4 count < 200 cells/u, without marked regional diiferenAes. Antifungal therapy wa s fir more frequently used in patients from northern Europe
compared with patients from central and southern Europe (25%, 10%, 10%, respectively
p0 ()!) tpatients (8%) with a CD4 count < 100 cells/ul received pnimary prophylaxis to prvt tte occurrence of nron -tuberculous mycobacteriosis.
Conclusion: ARV and antifungal therapies are used very differently in different parts of
Eurocc, whereas primary PCP prophylaxis is uniformly administered to most at-risk
fiatiets. i S recomendati on use of anti -mycobacterial prophylaxis have not been
it ipiirierii r is I:urope.
J.D. I ii dFren.c urr olDA coor dinating centre, Dept. Infect. Dis. ( 44), Hvidovi-e Hospital,
265( fvi d oe, Denmark. Phone: [phone]; FAX:[phone];
em r F ilDAainet.un c.dk
Tu.B.2153
THE CHARACTERISTICS OF INDIVIDUALS PRESENTING WITH AN AIDS DEFINING
ILLNESS COINCIDENT WITH THEIR FIRST POSITIVE HIV TEST RESULT AND THE
PSYCHOLOGICAL SEQUELAE OF LATE PRESENTATION
PLtcr klenshw P fede B ' Royal Londo t; Hpil;St. Bartholomew's
Hospfital, ondon, Enpand
Objective: 1 cdentify c and compare the psychological profiles and quality of life of individuals preeOt rng with their first AIDS defning i ness concurrent with their first positive HIV
test Croup I), with those having previous knowledge of their HIV positive status (Group
2) Reasons for ate presentation with HIV will also be identified.
Methods: As part of a iongitudinal study 30 persons presenting with a first AIDS defining llness were recru ted. Initial nterviews were conducted assessing individuals' knowledge of
HIV nfection and risk behaviours, awareness of personal vulnerability attitudes towards
testing reasons for testing and not testing for HIV and cognitive attributions for health
problems. Measures included anxiety and depression (HAD), GHQ, Mental Adjustment to
HIV Scale (MAH), and Quality of Life (MOS 30).
Results: Initial reults P n- 16) suggest no significant differences on most psychological measure, with ithe irst four weeks of an AIDS diagnosis between Groups I and 2. Both
groups self-rated low on knowledge of HIV Late attenders rated lower on maintaining safer
sex and reported greater shock at diagnosis. Reasons for late presentation were varied
ncluding a low perception of risk or an awareness of possible infection but having chosen
not o test. roup havye less belief that they can influence the course of disease. Early
accs to medo intervention, taking part in drug trials, having physical health monitored
and frag a HIV test to reduce uncertainty about health (p<_0.05) were rated as less
importt b/y Group I.
Conclusions: Initial distress cis simlar between individuals following first AIDS-defining illness
irrespective of whether they were aware of their HIV -positive status prior to diagnosis.
tie presenters with AIDS have a lower perception of risk of contracting HIV and rated
ith emselves as having been less successful at maintaining safer sex.They may be a group
who ire rot beng r eached by health education messages and reasons for this require further study
Jern Petrak, Clnial Pschology, Ambr os Ke King Gentre, Roya London Hospital, London,
Lor Jon, Whitechapel F I BB Tel: [phone] Fax: 0171t-377-7648
Tu.B.2154
THE OI REPORT:AN ANALYSIS OF THE STANDARD OF CARE FOR THE TREATMENT AND PROPHYLAXIS OF AIDS-RELATED OPPORTUNISTIC INFECTIONS.
Marcoji thatcDierz F Hor in T Morrison L, SmartT Sonnabend J,Wansor PWilder E,
Hrrngtonr M. T he Opportu isic t Ion C ommittee of the Treatment Action Group,
New York, NY USA.
Objectives: To assess the current state of research on and current prophylax s and treat
mer tfor AIDS related opportunistic infections (Ols), and to recommend improvements.
Methods: Current terature was reviewed and over 50 interviews were conducted with
le ',n c ademic rese frchrs, National Institutes of Health (NIH) administrators, industry
repr esentatives, clinicians, ianid treating physicians.
Discussion: The most nrficant advances in AIDS research have been the clinical success of
eval atng agents which have been proven effective for the prophylaxis and the treatment
oftt ie ma lcife thre, teyn Is), ncludingr rnycobacterum ivtium (MAC), pneuna ocysts
ir arii.on a and trlcandidiasis. Breakthrough from prophylaxis, recrudescence and
ii tc ti er perti opton is ommton.There are, however, inadequate treatment
oo for other Ols inldin2, cytomegalovlrus encephalitis, cryptosporidiosis,
rspondosis and PML which cause severe morbidity and mortality in many patients
w /' ff2 dsetse. Besdeft findny adequate therapies which must still be tested to prove
t. ii,, at-hi, ~now re now attemptinp to iprove their ability to dianos tl
pirfe'ltii-tf lis t ifcrm resistance and establish prog nostic markers for those patent
rn i t,k for selected )Is.
Conclusions: Intensified efforts are needed to elucidate the cur-rent standard of care for
AlLS reited Odls and to determine areas of crtical attention. Policy recommendations have
betssued calln for cooper tion and collaboration between NIH institutes. AIDS clinical
ti ia riws, he pharman utical and botechnology ndustries and treating physicans
MFiche tiacoTAG, I05 West 73rd Street # ID, NewYork, NY 10023,USATelephone: 2 2
87r 90!, Fax: 2 n2-877 0196 E mail: [email protected]
Tu.B.2156
EFFECTIVENESS OF HOSPITAL INTERVENTIONS ON IMPROVING SURVIVAL OF
AIDS PATIENTS ST.MARY'S HOSPITAL, LONDON, 1982-1991

Beck duard I, Mandala S*, Srodzinski K*, Wadsworth J*, Miller DL*, Pinching AJ**, Haris

JRW*. 'St.Mary's Hospital Medical School, Imperial College and **Medical College of St.
Bartholomews Hospital, London.
Objective: To assess the effectiveness of hospital interventions on su vival of first episode of
PCP in AIDS patients and survival from diagnosis of AIDS for those who survived their first
episode of PCP
Method: Retrospective study of 159 patients with first episode PCP managed at St.Mary'
1f982- 99 1. Multlinear logistic regression models analyzed epsode survival and Cox's pro
port ion, rlhazards models survival from diagnosis of AIDS.
Results: The reduction in case fatality of first time episodes PCP significantly contributed to
improved median survival from diagnosis of AIDS which increased from 202 days to 622
days since 1987 (Logrank X2= 18.3,p=0.000I). Increased episode survival was assoated
with being an index episode, haemoglobin at diagnosis greater than 12 g/dl and time inter
val between diagnosis of HIV and first episode of PCP longer than two years in cytologically
confirmed cases of PCP; presence of concurrent AIDS conditions reduced likelihood
episode survival as did presenting with an A-a gradient greater than 40 mmHg in older
patients, especially if they had PCP before 1987. Patients who had more than 16 outpatient
visits before their first episode of PCP were less I kely to present with an A-a gradient
greater than 40 mmHg. Haemoglobin levels of less than 12 g/dl were significantly associated
with lymphocyte counts less than 500 cells/mm3. For the 126 individuals who survived their
frst episode of PCP death after this episode of PCP was more Ikely in older patients with
pre-existing AIDS diagnoses, and less likely in patients regularly seen in outpatients after
thei fir rst episode of PCP those who had less severe chronic disease (annual reductions in
haemoglobin less than 3 g/dl) and treated with PCP prophylaxis (primary or secondary)
acyclovi or zidovudines snce their first episode of PCP
Conclusion: aly 0inois of HIV-I nfection with regular medical follow-up before and
after first episode of PCP with treatment of opportunistic cllnesses and the underlying
mmunosuppress ion, sgnificantl y red uced the likelihood of dying during and after the first
episode of PCPTr-eatment with zdovud ce, acyclovir and PCP prophylaxis, though not associated with episode survival, were significantly associated with longterm survival
E. J. Beck, Department of Epidemiology & Public Health, St Mary's Hospital Medical School,
Norfolk Place, London W2 I PG.TeI.: ++ 0 7 1-725-27 18, Fax: ++017 1-402-2150, email:
[email protected]
Tu.B.2157
THE USE, COST AND OUTCOME OF HOSPITAL SERVICE PROVISION FOR HIV
INFECTED CHILDREN ST MARY'S HOSPITAL LONDON 1986-94
Mandal a Sundhiya*, Beck EJ*, Grffith R*, Walters MDS**, Levin M**, Boulton M*, Miller
DL.*. 'Department of Epidemiology and Public Health and "**Department of Paediatncs
St. Mary 's Hospital Medical School, Imperial College, London
Objective: To describe the use of hospital services and associated costs by stage of HIV
infection for children attending St Mary's Hospital, London, 1986 to 1994.
Methods: Data on the use of hospitaI services were abstracted retrospectively from case
notes for I 8 of the I 9 children seen between I January 1986 and 31 December 1994
Demographic data and data on inpatient (IP) episodes, outpatient (OP) visits, IP and OP
tests and procedures performed and drugs prescnibed were abstracted from case notes.
Unit costs were calculated for each service activity through a costing exercise of all departments involved with paediatric HIIV care Mean service activity and associated average costs
are described per patient-yearn Kaplan-Mlcr analyses were used to estimate mredian time
nterval at each stage of HIV infectiorn.
Results: Mean inpatient days and outpatient visits for indeterminate children was 8.6 and
5.2 respectively per patient-year and 0.8 and 4.8 for asymptomatic, 13.7 and 7.5 respectively
for children with symptomatic non AIDS and 4.2 and 9.5 per patient year for children with
AIDS. Mean IP and OP tests performed and drugs prescribed was 16.5 and 437 respectively per ndeterminate patient-y ear 24. Iand 142.8 per iasymptomatic 52.8 antd 372. I per
symptomatic non-AIDS and 188.2 and 986.8 respectvely per AIDS patent-year: Associated
costs per patient year by stage of HIV infection will be presented. Increased use of hospital
services was generally reflected in increased costs. Median time interval frhom indeterminate
to asymptomatic stage was 12 monthis, from asymptomatic to symptomatic non AIDS 1.6
months, from symptomatic non -AIDS to AIDS 22 months and from AIDS to death 30
months.
Conclusions: At this stage of the paediatric HIV epidemic, hospital service provision is predominantly inpat ient based, which partly relates to the hospital acting as a national referral
centre. Children with symptomatic non-AIDS and AIDS used hospital services most intensively which is also reflected in their respective costs.
S. MandaIa, Department of Epidemology and Public Helath, St Mary 's Hospital Medical
School, Norfolk Place, London W2 I PG.Tel.: [phone] Fax: [phone] email:
s.mandala( sm.ic.ac.uk
Tu.B.2158
MONITORING THE EFFECTIVENESS, EFFICIENCY AND ACCEPTABILITY OF
ENGLISH HIV-SERVICE PROVISION PROSPECTIVELY:THE NPMS
Egan Mity. Grif6th R Srodznski K, Beck E J. Departnent of Epidemiology and Public
Health, St Marys Hospital Medical School, Imperial College, London.
Issue: The need for a National Prospectve Monitonrng Systems (NPMS) on the use. cost
and outcome of sevIwe prosion n Englsh HIV units was assessed.The aim of the NPMS
would be to imonItor the effectiveness, efficiency and acceptability of servwce proison in
English HIV hosptal units
Project: To assesv prospectively the effectiveness, efficiency and acceptability of HIV service
provision standardised actvty ease severity economic and acceptability data need to be
collected on a multicentre basrs. Activwty and Cae Seventy data would be collected Iongitudinall and Acceptabihty and Economic data on a cross-sectIonal bass.The need for and
feasibihty of establishing the NPMS was assessed among both Purchasers and Providers of
English F-IIV servce. A self completion questionnaire was sent to all I 0 English District
Health Authorities (Purchasers) and semi-structured interwews were held with the Heads
of 20 HIV Hospital Units (Provders): the latter ircluded the man Englrsh HIV centres, generating over 50% of AIDS notifcations.
Results: Both Purchasers and Providers were in fiavour of estabhshing the NPMS. Purchasers
stated that the regular provision of activity and cost data would be the greatest beneit to

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