To evaluate the natural history and the impact that different strategies have had on
HIV infection and its associated conditions, a cohort of 970 patients (432 had
AIDS) who had been seen over a period of 13 years were studied. The incidence of new HIV-infected patients had increased steadily since 1985, peaking in 1993 (52.9 cases/100,000 population), to significantly decrease in the subsequent years. The most common
AIDS-defining illnesses (ADIs) were
tuberculosis (52.3% of the patients),
Pneumocystis carinii pneumonia (30%), and candidal
esophagitis (28.6%). The frequency of new cases of
tuberculosis per patient with ADI clearly decreased over this period (p < 0.0001), whereas that of P. carinii
pneumonia decreased slowly until 1994, to fall thereafter to about half the previous levels (p = 0.005). Candidal
esophagitis showed a biphasic pattern, the second peak probably due to the emergence of
fluconazole resistance. The number of ADIs per patient increased from the beginning of the observation period, peaking in 1995 (1.67 ADI/patient), followed by a statistically significant decrease that, in 1997, reached the 1987 levels (1.22 ADI/patient). We conclude that the clinical spectrum of
HIV infection is improving in the last years. Except for
tuberculosis, prophylaxis for other ADIs, although effective, does not seem to have had a dramatic impact on occurrence. The most impressive reductions have been observed only after the introduction of antiretroviral combination
therapy.