Survival in a cohort of 1205 AIDS patients from Milan.

The authors report their findings from an assessment of survival in a group of 1205 AIDS patients diagnosed consecutively at the Clinic of Infectious Diseases in Milan during 1984-94. 64% were IV drug users while 2% were infected through blood transfusions. Zidovudine (ZDV) was licensed for use at the end of 1987 and guidelines for Pneumocystis carinii pneumonia (PCP) prophylaxis were produced toward the end of 1989. The patients were therefore divided into three groups for the purpose of this study. 185 patients were diagnosed as having AIDS during 1984-87 404 during 1988-90 and 616 during 1991-94. PCP was the index disease in 292 patients esophageal candidiasis in 202 toxoplasmic encephalitis in 134 cytomegalovirus (CMV) disease in 114 Kaposis sarcoma in 109 and AIDS-dementia complex (ADC) in 102. 123 patients had multiple index diseases. Multivariate analysis found being older than age 35 years having CMV toxoplasmic encephalitis ADC and multiple and infrequent index diseases to be independent factors of a shorter survival while a CD4 cell count of more than 100 x 10 /l and a diagnosis of AIDS in 1988-90 were associated with a longer survival. Survival times are as follows: median 11 months; mean 17.4 months; 46% still alive at 12 months 22% at 24 months and 11% at 36 months. The survival time of these patients was shorter than that of 176 Italian hemophiliacs in Ghirardinis research; their overall median survival was 17 months. The authors suspect that the lower survival time of their patients may be due to their considerable immunodepression at the time of AIDS diagnosis. They note that the survival of the hemophiliac patients with CMV disease was the same as that of the patients with PCP and argue that the administration of ZDV after AIDS diagnosis should be considered as an indicator of a better prognosis and not just associated per se with a longer survival.