The spectrum of HIV-1-related disease among outpatients in New York City

Objectives: To define the spectrum of HIV-1-related disease in New York City (NYC) and to determine how the clinical spectrum of illness differs in various populations. Design and methods: The medical records of the 2983 HIV-infected individuals who had received care through 1989 at four hospital outpatient clinics and two private physicians' offices were reviewed retrospectively. Results: Sixty-one per cent of the study patients and 48% of patients seen in 1989 had AIDS. HIV-infected women were significantly less likely to have AIDS and CD4 lymphocyte counts <200 x 10⁶/l than men. For every 100 AIDS patients seen in 1989, there were 88 non-AIDS patients with CD4 counts <500 x 10⁶/l, of whom 41 had CD4 counts < 200 x 10⁶/l; thus, in addition to an estimated 16425 individuals living with AIDS in NYC, we estimate that there are at least 14454 HIV-infected individuals without AIDS with CD4 counts < 500 x 10⁶/l, of whom 6734 have CD4 counts <200 x 10⁶/l. Men who have sex with men were significantly more likely to have Kaposi's sarcoma, cytomegalovirus disease and retinitis, cryptosporidiosis and lymphoma, and significantly less likely to have Pneumocystis carinii pneumonia, esophageal candidiasis, extrapulmonary tuberculosis (TB) and bacterial pneumonia than intravenous drug users. Whites were significantly less likely to have pulmonary TB than Hispanics, non-Haitian and Haitian blacks, toxoplasmosis than Hispanics and Haitian blacks, and salmonella septicemia than non-Haitian blacks. The frequencies of most diagnoses did not differ by sex; gynecologic diseases were recorded infrequently in the medical records of women in this study. Conclusions: These data indicate that there are more than 30000 HIV-infected adults living in NYC with significant immunosuppression, that an increasing proportion of AIDS cases in NYC will occur among women, and that the spectrum of HIV-related disease varies markedly in different populations.