Survival of AIDS patients in the emerging epidemic in Bangkok, Thailand

Survival from the time of AIDS diagnosis to death was determined retrospectively among Thai patients (> or = 13 years old) who attended a public tertiary care infectious disease hospital in a suburb of Bangkok, Thailand, from February 1987 through February 1993. An AIDS diagnosis was based on the 1987 Centers for Disease Control (CDC) definition, except Penicillium marneffei infection was included as an AIDS-defining condition. Of 329 AIDS patients, 152 (46.2%) had died. The median age at diagnosis was 31.5 years (range, 18-74) 306 patients (93.0%) were males. Reported risk categories were heterosexual contact (55.2%), injecting drug use (IDU, 22.6%), male homosexual or bisexual contact (9.5%), and unidentified risk or other (12.7%). Median survival time (Kaplan-Meier) for all patients was 7.0 months; 1-year survival probability was 39.2% (95% confidence interval [CI] = 31.5-46.9%). Cox's proportional hazards model showed three factors associated with survival: age, reported risk category, and presenting diagnosis. Patients aged 26 to 35 years survived longer (median survival time, 10.6 months; relative hazard [RH] = 0.61, 95% CI = 0.44-0.85, referent: others), as did patients in sexual risk categories (median survival time, 7.3 months; RH = 0.59, 95% CI = 0.40-0.78, referent: IDU and other categories). A single presenting diagnosis of extrapulmonary tuberculosis was also associated with longer survival (median survival time, 19.9 months, RH = 0.55, 95% CI = 0.35-0.86, referent: other diagnoses). AIDS patients in the early phase of the epidemic in Bangkok have much shorter survival times than patients in developed countries, in part perhaps because they are often diagnosed late in the course of HIV infection. Increased attention should be given to the early diagnosis and treatment of these patients.