Study Finds AIDS Patients Live Longer When Their Doctors Have More Experience Treating HIV

A study of 403 adult men diagnosed with AIDS from 1984 through 1994 within an HMO found large differences in survival depending on physicians' experience (measured in large part by how many AIDS patients they had cared for).(1)
"After AIDS diagnosis, median survival among patients of physicians with the least AIDS experience was 14 months, versus 26 months among patients of physicians with the most experience (P<0.001). After controlling for severity of illness and year of AIDS diagnosis, patients cared for by physicians with the most experience had a 31 percent lower risk of death compared to patients cared for by physicians with the least experience (P<0.02). The adjusted relative risk was 44 percent lower for patients of the most experienced physicians (P<0.02) among 244 patients diagnosed from 1989-1994, controlling for CD4 cell count and severity of illness."

Other data suggested that the difference may have been largely due to better use of PCP prophylaxis, including better monitoring to know when prophylaxis should begin. "Among 212 patients with CD4 cell counts of <200 mm3 prior to AIDS diagnosis, patients of physicians with greater experience had a significant increase in CD4 cell count monitoring (P<0.001), prophylaxis against Pneumocystis carinii pneumonia (PCP) (P<0.001), and a decrease in the proportion of patients diagnosed with PCP as their AIDS-defining illness (P=0.10)."

[Note: As this issue went to press, we learned that a full report of this research is due to be published in a couple weeks.]

Comment

This result should reinforce the importance of people finding out if they have HIV, and getting medical care if they do. No treatment at all -- including no PCP prophylaxis no matter how much it is needed -- is worse than treatment by the least experienced physicians. In the U.S. and some other countries, PCP prophylaxis is clearly the most important AIDS-related treatment in reducing the risk of death. And it is inexpensive, so there is seldom any economic obstacle to receiving it.

Also, this result suggests that HIV care does need to be a specialty among physicians, instead of being left to general practitioners. Inexperienced AIDS physicians should be working under supervision so that their patients can be assured of adequate care.

This finding also emphasizes the importance of the development of accepted guidelines and standards of care for HIV treatment. Today the situation is chaotic, with vast differences among physicians, and many patients receiving inadequate care.

References

1. Kitahata MM, Koepsell TD, Deyo RA, Maxwell CL, Dodge WT, and Wagner EH. Physician Experience and Survival Among Patients with AIDS. 3rd Conference on Retroviruses and Opportunistic Infections, January 28 - February 1, 1996, Washington DC [abstract #413].