Background: The characteristics of AIDS patients in Spain have already been described, as have the factors which may or may not be present at the time of AIDS diagnosis influence in the prognosis. The introduction of zidovudine and later other antiretroviral drugs have improved the prognosis versus historical controls. Nonetheless, advances in prevention, control and the treatment of opportunistic infections have provided the greatest influence in the development of clinical manifestations of AIDS: The aim of the present was to study the evolution of AIDS patients seen at the Hospital Clínic in Barcelona, Spain, from 1985 to 1992 and analyze the variations in the time of clinical manifestations and survival.
Methods: The clinical records of 1187 patients in the Hospital Clinic in Barcelona with HIV infection who developed AIDS (1985-1992) according to the CDC criteria of August 1987 were retrospectively reviewed.
Results: Out of the 1187 AIDS cases, the percentage of women rose from 8% to 25%. The route of HIV infection which has most varied over time has been that of heterosexual relations (68%). Despite being the most frequent form of AIDS presentation, opportunistic infection has decreased from 79% to 51%. Tuberculosis, pneumonia by Pneumocystis carinii and cerebral toxoplasmosis as forms of presentation have also decreased on performing routine primary prophylaxis for these opportunistic infections. A significant trend towards improvement in survival over time was observed, mainly due to better prognosis of patients in whom AIDS diagnosis was obtained due to pneumonia by P. carinii or Kaposi's sarcoma.
Conclusions: There has been an increase in the percentage of women and heterosexual transmission in AIDS, as well as an important change in the form of AIDS presentation probably due to the systematic administration of primary prophylaxis for several opportunistic infections. There has also been a global improvement in survival.