AIDS Treatment Update, Issue 54, June 1997
Keith Alcorn

UK SURVEILLANCE STATISTICS

The UK's national and regional HIV/AIDS statistics show no evidence of a fall in the number of people newly diagnosed with AIDS during 1996. Indeed, nation-wide more people were newly diagnosed with AIDS in 1996 than in any preceding year, with an increase of over 200 cases compared with 1995.

The increase in new AIDS diagnoses was observed in all regions, and was accompanied by an increase in AIDS deaths in both North-West and Yorkshire regions. However, the number of AIDS deaths fell in every other region; the reduction was most marked in North and South Thames. One possible interpretation is that the increasing use of combination therapy has helped to prevent AIDS deaths in regions other than the North-West and Yorkshire, although other factors may also be important.

According to the Communicable Disease Surveillance Centre (CDSC), which collects AIDS and HIV reports, it may take some years to identify all the AIDS-related deaths which occur in any given year, because AIDS is not always cited as the cause of death on a death certificate. This means that CDSC staff must go through the registry of deaths in an attempt to identify likely AIDS deaths by location, and then match those up with health authority records.

Trials of anti-retroviral therapy have suggested that reductions of 40 to 50% in death and illness over 18 months to three years of follow up are to be expected, but to see such reductions in the whole population of HIV infected people a number of conditions will have to be met:

* access to treatment throughout the UK

* earlier detection of HIV infection

* greater uptake of treatment

* adherence to treatment regimens

Whilst reports of ward closures and reductions in hospitalisation are coming from centres in London, it is unlikely that such trends will translate into a substantial and sustained fall in AIDS diagnoses during the rest of the decade, unless the four criteria listed above are met. In the longer term, lasting benefits will only be seen if the short-term benefits of current treatment regimens can be sustained for years.

EDINBURGH, BRIGHTON & LONDON

A survey of hospital resource use during 1996 at Edinburgh City Hospital, presented at the recent British HIV Association (BHIVA) conference, indicates:

* 40% decline in HIV-related hospital admissions compared to 1995

* 40% decline in AIDS deaths compared to 1995

* 42% reduction in AIDS diagnoses

* an increase in the proportion of patients receiving anti-retroviral therapy from 24% to 49% between 1994 and 1996

However, the Edinburgh team are cautious about the potential long-term impact of combination therapy. They note that a similar reduction in hospital activity levels was seen in 1987 following the introduction of AZT monotherapy, but its benefit was short-lived.

In Brighton, the number of AIDS diagnoses increased during 1996. However, death rates (defined as deaths per hundred patient years) fell from 12.6 in 1995 to 1.8 in the first quarter of 1997. Demand for in-patient care (defined as number of bed days per hundred patient years) also fell from 513 in 1995 to 136 in the first quarter of 1997. At the same time, the proportion of all patients at the clinic who are taking anti-HIV drugs has increased from 16% in 1995 to 56% in 1997.

At the Mortimer Market Centre in London, the uptake of anti-retroviral therapy among people with CD4 counts below 300 has increased from about 20% prior to the results of the Delta trial in late 1995, to 55-60% in February/March 1997. Dr Ian Williams predicts that this figure is likely to increase still further over the coming months.

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