The almost 21,000 medical records in the survey are even more detailed than those kept by the federal government, and include information gathered at diagnosis as well as follow-ups every 18 to 24 months.
Information included CD4 counts (AIDS is defined as the time when the CD4, or a type of white blood cell, falls below a count of 200) and each patient’s viral load. The records also showed whether patients received immunizations against deadly, opportunistic infections common to AIDS patients, such as Pneumocystis pneumonia (PCP) and Mycobacterium avium complex (MAC) as well as other causes of death.
The records were divided into three treatment eras: 1981-1986; 1987-1996; and 1997-2012.
Medications to fight HIV evolved significantly through each of those eras and continues to become more effective. In the early era — before the advent of HIV-suppressing drugs — only 7 percent of people with AIDS-related opportunistic infections lived five years or more, the study found. But in the most recent era, 65 percent lived five years or longer, the research showed.
Why are people doing better now, relative to the 1980s and early 1990s? The researchers credit not only more effective medications, but also the widespread availability of HIV testing in San Francisco, better access to care, and more effective prevention messages.
Nevertheless, 35 percent of HIV-infected people in the study who acquired an opportunistic infection in 1997-2012 still died within five years, Schwarcz and colleagues reported.
There are ways to lower those numbers, Schwarcz said.
“Number one, get diagnosed early,” she said. “Individuals as well as clinicians need to be promoting testing. Early treatment, adherence to treatment, as well as being on the lookout for a range of HIV-related [illnesses], including opportunistic infections, is important.”
Schwarcz, who is also senior HIV epidemiologist at the San Francisco Department of Public Health, said doctors also need to discuss medication side effects — a prime reason for treatment lapses — with their patients. Often, doctors can work with patients to help minimize side effects so that medications continue to be taken as directed.
Other issues in a patient’s life, such as whether they have stable housing or a drug and/or alcohol problem, also need to be monitored to ensure adherence, Schwarcz said.
She pointed out that the demographics of San Franciscans with HIV/AIDS has shifted over time — away from gay, white men to men of color and women.