Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 13236-13239 133

(10): cervical cancer (5.6); rectal cancer (5.5); lung cancer (5.0); uterine cancer
(4.5); oral cancer (4.5); kidney or urinary bladder cancer (2.8); and leukemia (2.5).
Total cancer mortality was increased 33-fold among HIV-infected men and 8-fold
among women; relative risks for all cancers other than KS and NHL were 2.4
among men and 2.3 among women.
Conclusions: HIV-infected persons have an increased risk of death with cancers other than Kaposi's sarcoma and non-Hodgkin's lymphoma. Factors other
than HIV infection, such as smoking, alcohol consumption, and sexually transmitted infections, may account for some of this excess risk.
13236 Opportunistic infections in the United States: Focusing
health care and needs for people with AIDS
Haftan Eckholdt', J.J. Chin2, C. Harris3, D. Kim4. 'Albert Einstein College of
Medicine KC 923/1300 Morris Park Ave 10461; 2Asian and Pacific Islander
Coalition on HIV/AIDS New York NY; 3American Indian Community House New
York NY; 4Saint Vincent's Hospital New York NY USA
Background: Past efforts to measure health care access, delays in diagnosis,
and health cost have focused on individual opportunistic infections excluding
some groups due to low frequency (Asians and Pacific Islanders and Native
Americans). We measured the total number of AIDS indicator infections to further
our understanding of health care needs especially for lower frequency groups.
If meaningful, this measure would help health care providers target groups in
greatest need of outreach efforts for earlier HIV/AIDS diagnosis and treatment.
Methods: Data on the total number of AIDS indicator infections among adolescents and adults diagnosed with AIDS in the US from 1981 through December
1994 (N = 441,528) were analyzed using the Centers for Disease Control and
Prevention's AIDS Public Information Data Set. The analyses of the data included
chi-square, t-test, and linear regression, and Poisson regression.
Results: Initial analyses (p - 0.001) showed that the mean number of presenting opportunistic infections was related to mean survival time, as well as
probability of death. Regression analysis (p -: 0.001) showed that the number of
opportunistic infections was related to Race (Asian/Pacific Islanders and Native
American highest), mode of Exposure (Intravenous Drug Use + Men who have
sex with Men (IDU + MSM) and MSM were highest), Region of Residence (Central
US the highest), Year of Diagnosis (earlier years higher), and Age group (younger
higher). There were no differences in number of infections between sex groups
or country of birth groups.
Conclusions: Relationships with survival time and death suggest that number
of infections is meaningful and relevant in HIV/AIDS care research. Differences
between: (1) Race groups and Regions of residence may be indicative of systematic barriers to health care, (2) Exposure groups suggest the role of prior
exposure, and (3) Year of diagnosis show trends in the successful treatment of
some infections. The identified groups need to be targeted for early HIV treatment
interventions.
13237 Decreasing trends in wasting syndrome and failure to
thrive among perinatally HIV-infected children in Puerto
Rico
Idith Ortiz', R.G. Lugo2, C.M. Perez3, E. Suarez3, I. Febo3, I. Mendez4,
R. Aguayo5, J. Vazquez6, R. Delgado7, J. Bertolli8. ' UPR School of Medicine,
Dept of Pediatrics, GPO Box 365067, San Juan; 2Puerto Rico Department of
Health, San Juan, PR; 3University of Puerto Rico, San Juan, PR; 4San Juan
Department of Health, San Juan, PR; 5Puerto Rico Department of Health,
Bayamon, PR; 6Puerto Rico Department of Health, Caguas, PR; 7Puerto Rico,
Department of Health, Ponce, PR, Puerto Rico; 8Centers for Disease Control
Prevention, Atlanta, GA, USA
Background: Wasting Syndrome (WS) accounts for 17% of AIDS Defining Conditions reported among children with AIDS in the USA and 28% of pediatric cases
in Puerto Rico, (P.R.). Active surveillance for pediatric HIV infection is being conducted by the Pediatric Spectrum of Disease Project (PSD) in several geographic
areas of the USA including P.R. The cumulative incidence of WS in the AIDS
cases monitored in this study, excluding P.R., is 16% while it is 41% in the P.R.
data. Differences in diagnostic or treatment practices have been proposed as an
explanation of the high incidence of WS in P.R.
Objective: To describe and compare the trends in the incidence of WS and Failure to Thrive (FTT) not attributed to WS among perinatally HIV-infected children
in P.R.
Methods: We analyzed data on 460 perinatally HIV-infected children monitored
for a total of 2619 person-semesters, (p/s) in the PSD study in P.R. from 1992 to
1997. This study collects data from medical records at six-month intervals. Incidence density of WS and FTT were calculated by year of diagnosis. A Poisson
regression model was used to examine trends over time.
Results: Of the 460 perinatally HIV-infected children monitored, 11% had WS
with an incidence density of 19 cases per 1000 p/s and 41% or 70 cases per
1000 p/s had FTT not diagnosed as WS. The WS and FTT cases per 1000 p/s by
calendar year were: 1992: 60 vs 172; 1993: 22 vs 80; 1994: 8 vs 33; 1995: 2 vs
12; 1996: 2 vs 10; 1997: 0.3 vs 3. The average rate of decline for both conditions

is 59% per year (95% Cl: 55%, 63%).
Conclusion: A significant and persistent decreasing trend has been observed
in the occurrence of both WS and FTT among our study population. Further
investigation is required to determine whether this trend is likely due to changes
in diagnostic or treatment practices.

13238 Lifetime prevalence of opportunistic infections in a
nationally representative sample (HCSUS) of HIV-infected
persons in care
Allen McCutchan', S. Bozzette2, M. Shapiro2, B. Turner3, S. Asch2, A. Gifford4,
J. Keesey2. ' University of California, UCSD Treatment Center, 2760 Fifth Ave.
Suite 300, San Diego, CA 92103; 2RAND, Santa Monica, CA; 3Jefferson Medical
College, Philadelphia, PA; 4 Veterans Administration, Med. Ctr., La Jolla, CA, USA
Background: Data on relative incidence of major opportunistic infections (Ol's)
in the USA has been based on CDC surveillance reporting which captures incidence at diagnosis of AIDS (ARS) and a systematic review of the records of
5,969 patients in 10 metropolitan areas by the Adult Spectrum of HIV Disease
Project (ASD, AIDS 1994 8:1489).
Methods: The HCSUS cohort is a nationally representative probability sample
of HIV-infected persons in care. This analysis uses the final sample of 1,126 AIDS
patients with a history of an opportunistic condition; preliminary weights to adjust
for sampling, multiplicity, and nonresponse; and linearization methods to correct
for the weights and the multistage sample design. Lifetime prevalence's of major
Ol's were ascertained by self-report (computer-assisted baseline patient survey)
between 1/96 and 3/97. These lifetime Ol's prevalence rates were compared to
the percentage of patients with each 01 either reported to the CDC with AIDS
defining conditions in 1990-1992 and 1996 {AIDS Reporting System (ARS),
HIV/AIDS Surveillance Report 8:18, 1997} or found by ASD.
Results: Lifetime prevalences of Ol's in the HCSUS sample resembled the
prevalence of Ol's at diagnosis of AIDS reported to the CDC/ARS for invasive
fungal infections (predominantly cryptococcosis), PCP, and toxoplasmosis, but
were more similar to that found by the ASD for CMV, which is a complication of
advanced AIDS. The rate of the other common complication of late AIDS, MAC,
is markedly reduced in the HCSUS/1996 (10%) compared with ASD/1990-1992
(23%), possibly reflecting increasing use of chemoprophylaxis for MAC by 41%
of eligible patients (CD4 < 50) in HCSUS sample.

Ol
Invasive fungal infections
Cytomegalovirus retinitis (CMV)
Mycobacterium avium (MAC)
Tuberculosis (MTB)
Pneumocystis (PCP)
Toxoplasmosis (Toxo)

Source HCSUS ARS
Year(s) 1996 1996
5 6.0
15 4.2
10 6.0
13 7.1
38 39
5 4.7

ARS
1992
5.0
7.1
9.6

ASD
1992
8.7
16.2
23

51 57
4.4 6.4

Conclusions: Rates of Ol's in HCSUS resemble those of CDC/ARS in 1992
and 1996 for "early" occurring Ol's, and of ASD for CMV, a "late" occurring 01,
consistent with differences in the stage of AIDS during which data is collected.
The CDC/AIDS Reporting System underestimates late complications of AIDS that
are captured by HCSUS and the ASD. Rates in the ASD was comparable to
that in HCSUS except for a decline in MAC from 1992 (ASD) to 1996 (HCSUS)
possibly reflecting effects of the adoption of MAC prophylaxis.
S13239 Decreases in HIV-related morbidity, mortality, and health
care utilization related to highly active antiretroviral
therapy (HAART)
David L. Cohn 2, A.J. Davidson2, W.J. Burman2, V.J. Coca2, R.R. Reves2,
C.A. Rietmeijer2. 1605 Bann Ock Street, Denver Colorado 80204; 2Denver
Public Health, Denver, CO, USA
Objectives: To monitor trends in HIV-related opportunistic diseases (OD), mortality (MORT), and health care utilization (HCU) in a municipal health care system
before and during the era of HAART.
Design: Prospective, observational, incidence-density study (per 100 personyears).
Methods: Since 1990, Denver Health (DH), an integrated muncipal health care
system and largest HIV care provider in Colorado, has recorded HIV-related OD
and MORT using CDC's HIV/AIDS Reporting System (active surveillance) and
Adult Spectrum of Disease Study (6-month chart review). HCU was calculated
from DH's billing system.
Results: Of 3,229 HIV-infected patients (pts) at DH, incidence of first-episode
OD and MORT in 4 time intervals was:
PCP MAC CMV CE BP WS KS LYM MORT
1990-1991 8.0 4.7 2.6 4.1 1.3 2.3 4.6 1.2 12.7
1992-1993 6.5 5.0 3.5 3.9 1.6 1.0 2.7 0.8 12.7
1994-1995 5.7 4.1 4.0 3.8 1.3 0.3 2.6 0.9 13.9
1996-1997 4.1 2.4 2.2 1.9 0.7 0.3 2.0 0.7 9.9
CE = Candida esophagitis; BP = Bacterial pneumonia; WS = Wasting syndrome; LYM = Lymphoma *X2 for trend: p - 0.05
HCU and inpatient charges were (adm = hospital admissions; LOS = length of
stay):

1990-1991
1992-1993
1994-1995
1996-1997

No. pts
1363
1870
1969
1713

No. adm
991
1152
1290
757

Adm/pt
0.72
0.62
0.66
0.44

Mean LOS
7.8
6.4
5.7
5.7

Charges/pt
$8,127
6,422
7,216
5,422

Total charges
$11,077,000
12,010,000
14,208,000
9,288,000

Conclusion: Between 1990-1997, by 2-year intervals, before and during
HAART, there was a decrease of 41-87% in incidence of OD, 29% in mortality,