Improved short-term survival of AIDS patients initially diagnosed with Pneumocystis carinii pneumonia, 1984 through 1987
J. E. Harris
Department of Economics, Massachusetts Institute of Technology, Cambridge 02139.
I analyzed trends in the survival of 36,847 adults who were diagnosed with
acquired immunodeficiency syndrome between January 1984 and September 1987
under the pre-1987 surveillance definition of acquired immunodeficiency
syndrome. For patients in whom Pneumocystis carinii pneumonia was among the
first manifestations of acquired immunodeficiency syndrome, the estimated
1-year survival increased from 42.7% for those diagnosed in 1984 and 1985
(95% confidence interval, 41.5% to 44.3%) to 54.5% for those diagnosed in
1986 and 1987 (95% confidence interval, 53.7% to 55.7%). The gain in
survival was observed in homosexual men and intravenous drug users of both
sexes, in all age and racial groups, in all geographic regions, and in
patients with and without coexisting initial diagnosis. Reduced mortality
in the 3-month period immediately following the initial diagnosis of
acquired immunodeficiency syndrome contributed little to the overall gain
in survival. No gain in survival was seen for patients in whom P carinii
pneumonia was not an initial manifestation of acquired immunodeficiency
syndrome. It is unlikely that the observed improvements in survival
resulted solely from errors in death reporting. Better diagnosis and
treatment, particularly the introduction of zidovudine in 1986, may have
contributed to the decline in mortality.
