Decline in AIDS-Related Deaths
and Hospitalizations
by Liz Highleyman
Recent media reports and anecdotal data suggesting positive results among
those using new antiretroviral drugs and combination regimens are borne
out by statistical data from several U.S. cities. (Note: due to a delay
in reporting of deaths, many health departments are able to report reliable
figures only for the first 6 months of 1996.)
Nationwide
In the February 28, 1997 issue of Morbidity and Mortality Weekly Report,
the Centers for Disease Control and Prevention (CDC) reported a "marked
decline" in the number of AIDS-related deaths in 1996, the first
decrease in the history of the epidemic. The number of deaths declined
12% from 24,900 in the first 6 months of 1995 to 22,000 in the first half
of 1996.
Death rates decreased for all racial/ethnic groups, but by considerably
different amounts; the death rate decreased by 21% for whites, 10% for
Latinos, 2% for African Americans, 6% for Asians/Pacific Islanders and
32% for Native Americans. Among women, however, the AIDS-related death
rate increased by 3% (compared to a 15% decrease for men as a whole).
By transmission category, death rates declined by 18% for gay/bisexual
men and by 6% for injection drug users, but increased by 3% for those
infected through heterosexual transmission. By geographic region, AIDS-related
deaths decreased by 16% in the west, 15% in the northeast, 11% in the
midwest and 8% in the south.
CDC attributed the decline to "improvements in recent years in treatments
that delay the progression of HIV disease and prevent opportunistic infections,
coupled with the success of prevention efforts in slowing the growth of
the epidemic overall"; the CDC noted that it is "too soon to
determine the impact" of the use of protease inhibitor drugs.
San Francisco
Ling Hsu, an epidemiologist with San Francisco's Department of Public
Health AIDS Office, reports that the city's AIDS-related death rate has
fallen from 734 deaths in the first half of 1995 to 573 deaths for the
first half of 1996, a decrease of over 20%.
John Stansell, MD, Medical Director of the UCSF PositiveHealth Program
at San Francisco General Hospital, reports that the AIDS clinic has seen
a "dramatic slowing" of the death rate over the past 12-18 months;
he estimates that the decrease has been at least 50%. Stansell noted that
over the same period of time, the number of patients using the clinic's
services has not changed, but that patients were less sick. Stansell maintains
that the changes are traceable to the beginning of widespread use of combination
antiretroviral therapy. Protease inhibtors have been helpful but have
"only accelerated an already existing trend."
David Senechek, MD, who has one-third of his AIDS patients taking triple
combination therapy, has seen a reduction in deaths in his practice from
20 in 1994 to 4 in 1996. Los Angeles
Jane Rollins, an epidemiologist with the HIV Epidemiology Program of
the Department of Health Services of Los Angeles County, reports that,
according to provisional figures, AIDS deaths decreased from 1,206 in
the first 6 months of 1995 to 958 in the first half of 1996, a 20% decline.
In California as a whole, AIDS-related deaths declined 40% from 1995
to 1996, according to the state's Division of Health Services.
In a report from the Fourth Conference on Retroviruses and Opportunistic
Infections held in January, Peter Ruane, MD, reported a decrease in utilization
of hospital and home care resources at Tower Infectious Disease Medical
Associates, a private group practice of AIDS specialists in West Los Angeles,
between July 1994 and June 1996. Length of average hospital stay fell
from 3.36 days/month to 1.28 days/month. Ruane also reported an 87% decrease
in AIDS-related deaths among patients of the practice, which was especially
evident during the final quarter of 1996.
At the same time, the practice has seen an increase in outpatient visits
and a 3-fold increase in HIV-related drug costs, suggesting that healthier
patients are taking advantage of ambulatory rather than in-hospital care.
Ruane and colleagues concluded that "utilization of newer antiretroviral
agents...is associated with significant reductions in utilization of other
healthcare resources."
New York City
Two reports from the January conference concerned trends in New York
City, the city with the highest number of AIDS cases and deaths in the
country.
Mary Ann Chaisson and colleagues from the New York City Department of
Health reported that the average daily number of AIDS-related deaths decreased
by half, from 21 in November 1995 to 10 in November 1996. Overall death
rates fell 30% from 7,000 in 1994-1995 to 5,000 in 1996. The decrease
was seen in both men and women, and across ethnicities. The researchers
suggested that the decline was likely attributable to early diagnosis,
prophylaxis for opportunistic infections, new antiretroviral therapies
and increased AIDS care services due to a doubling of the city's Ryan
White CARE funding in 1994.
At St. Vincent's Hospital and Medical Center, Ramon Torres, MD, and colleagues
reported a 27% reduction in HIV/AIDS-related hospitalizations between
1994 and 1996. There was a 16% reduction in the average length of hospital
stay from 15.2 days in May 1995 to 12.8 days in March 1996, and a 24%
decrease in the hospital's average monthly AIDS patient census. At the
same time, there was a 33% increase in outpatient visits and a large increase
in inpatient pharmacy costs, as patients made more extensive use of new
combination drug regimens for HIV.
Philadelphia
The number of AIDS-related deaths in Philadelphia decreased from 750
in 1995 to 574 in 1996, a decline of 23%. James McAnaney, of the Philadelphia
health department, emphasized that the decline indicates that people with
AIDS are living longer, not that fewer people have the disease.
Boston
Erica Seigfried, a research analyst with the health department in Boston,
provided provisional data indicating that death rates in that city fell
from 539 for the first half of 1995 to 298 for the first half of 1996,
a 45% decline.
Kathleen Moore, Communications Director of Boston's AIDS Action Committee,
reports that deaths among the agency's clients have fallen from several
each week to 1-2 per week; however, the agency's caseload is the highest
it has ever been.
Chicago
Trends are not as positive in Chicago. According to James Murphy, an
epidemiologist with the Chicago health department, death rates in that
city fell from 478 in the first half of 1995 to 442 in the first half
of 1996. Murphy emphasized that this small decrease cannot be considered
significant because data is provisional and that 1996 death rates may
be adjusted upward as additional reports are received.
Miami
Officials from the Dade County Health Department's AIDS Surveillance
Unit provided data indicating that AIDS-related deaths have also declined
in the city with the third highest number of AIDS cases in the U.S. In
the first half of 1995, 737 deaths were reported compared to 593 deaths
in the first 6 months of 1996, a decline of 20%. For the state of Florida
as a whole, based on preliminary figures, there was a 25% decline from
4,400 deaths in 1995 to 3,300 in 1996. Florida health chief Annie Neasman
noted that many AIDS patients in the state are not yet receiving protease
inhibitor therapy, and that the decline in deaths is therefore likely
due to older antiviral drugs.
Interestingly, major U.S. cities are typically reporting decreases in
AIDS-related deaths of 20-25%, about twice the nationwide decline reported
by the CDC.
Liz Highleyman is on the editorial staff of BETA.
References
Center for Disease Control and Prevention. Update: Trends
in AIDS incidence, deaths and prevalence Ð United States, 1996. Morbidity
and Mortality Weekly Report 46(8). February 28, 1997.
Chaisson M and others. Declining AIDS Mortality in New
York City. Fourth Conference on Retroviruses and Opportunistic Infections.
January 22-26, 1997. Abstract #376.
Ruane P and others. Impact of newer antiretroviral therapies
on inpatient and outpatient utilization of healthcare resources in patients
with HIV. Fourth Conference on Retroviruses and Opportunistic Infections.
January 22-26, 1997. Abstract #262.
Torres R and Barr M. Impact of potent new
antiretroviral therapies on in-patient and out-patient hospital utilization
by HIV-infected persons. Fourth Conference on Retroviruses and Opportunistic
Infections. January 22-26, 1997. Abstract #264.
Page last updated 1 April 1997
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