HIV prevalence, projected AIDS case estimates: workshop, October 31 - November 1, 1989

Article Abstract:

A workshop on AIDS, attended by epidemiologists, statisticians, and mathematical modelers, was held during the fall of 1989. The primary topics were the prevalence of human immunodeficiency virus (HIV) and the number of new cases of acquired immunodeficiency syndrome (AIDS) that may be expected in the United States in the upcoming decade. The Public Health Service estimate of 1.0 to 1.5 million current cases of HIV infection was analyzed. Other studies conducted concurrently or after this 1986 estimate basically corroborate these figures, with the estimated current averages of between approximately 800,000 and 1.2 million HIV infections. The number of AIDS cases is expected to increase in the next four years, and between 52,000 and 57,000 cases are expected to be diagnosed in 1990. The importance of statistically estimating the number of prior HIV infections which are reflective of AIDS cases that have occurred was stressed. One statistical problem, however, lies in interpreting the apparently slowing rates of newly reported AIDS cases, a trend observed particularly among homosexual and bisexual men. The influence of zidovudine therapy (AZT) on AIDS statistics was also examined. The use of this drug in treating asymptomatic HIV-positive individuals has resulted in a temporary delay in the onset of AIDS in between one third to one half of the patients. Additional therapeutic benefits of zidovudine were also examined. An editorial note from the Centers for Disease Control has identified factors responsible for the slowing trend, which include the decrease in the number of new HIV infections in homosexual and bisexual men; the use of antiviral treatments that have extended the incubation period; and incomplete or slow reporting of new cases. Despite the slowing trend that has been observed since 1987, the need for additional health care services continues to expand. The fact that new HIV infections continue to occur remains a point of major concern. More medical and social services will be needed, along with continuous prevention efforts, for some years to come. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Zidovudine

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The 'Medicaidization' of AIDS: trends in the financing of HIV-related medical care

Article Abstract:

Although the average cost of providing lifetime medical care for a patient with AIDS ranges from $40,000 to $75,000, there is little information regarding the source of funds used for paying this expense. The present study addresses the issue of who pays the bills for this group of human immunodeficiency virus (HIV)-infected patients. Hospital discharge summaries maintained in databases by the states of California (1983 to 1987) and New York (1983 to 1988) were used to extract information regarding the employment status and payer for hospitalized AIDS patients in New York City, Los Angeles, and San Francisco. These three cities comprise approximately one-third of all AIDS cases within the United States. Over the course of the period studied, there was a conspicuous trend in movement from private insurance to Medicare, referred to as ''Medicaidization''. The incidence of AIDS has increased at a more rapid rate among blacks and hispanics, who tend to be poorer than whites. Because Medicaid eligibility is dependent on financial consideration, whites, blacks and hispanics were studied separately. While blacks and hispanics were found to have a higher probability of utilizing Medicaid, all three groups of patients with AIDS were found to show a ''Medicaidization'' over time. In Los Angeles, the possibility that an individual hospitalized with AIDS is likely to be a Medicaid beneficiary is approximately three times that of a patient with another diagnosis. This results, in part, because most persons with AIDS must qualify as disabled before receiving Medicaid. In California persons with AIDS qualify as disabled persons without the usual case-by-case review required for individuals with other diagnoses. In addition, the fact that Medicaid reimbursements are considerably lower than those paid by private insurers leads some physicians to refuse services to particular groups of patients. This leads to a concomitant migration from private physicians to institutional care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, AIDS patients, Medicaid, Insurance

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Projecting the incidence of AIDS

Article Abstract:

At the 1986 Coolfant Planning Conference, the first projection of the incidence of AIDS in the United States was made. A total of 270,000 cases nationwide were predicted by 1991. This estimate has provided a good guide for public health planning measures, although this estimate may prove to be a little high. The article by Bregman and Langmuir which appears in the March 16, 1990 issue of the Journal of the American Medical Association has based future predictions of AIDS cases upon a bell-shaped curve. The long and variable incubation periods that have been observed with AIDS makes the use of this curve for predictive purposes questionable. Recent data indicate that there are currently one million individuals in the U.S. infected with the human immunodeficiency virus (HIV), which makes the authors' prediction of 200,000 cases very low. Another study by Lemp et al., which projected the AIDS mortality in San Francisco, appears in the same issue. These researchers have supplemented their data with HIV prevalence surveys, AIDS incubation distributions, and average survival times of AIDS patients. The major area of uncertainty in this study lies in the accurate estimation of incubation distribution and the number of HIV-positive individuals. Data in this study omitted hemophiliacs, transfusion recipients and children. However, the estimates made by Lemp et al. are basically in agreement with the observed incidence through 1986. The development of new therapies will no doubt have a large impact on the duration of illness of AIDS patients. In forecasting health care needs, the number of patients at various stages of the illness and the rate of progression of AIDS will be a significant factor in public health planning. (Consumer Summary produced by Reliance Medical Information, Inc.)

AIDS-related complex, editorial

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