Background: Since the late 1980s the use of prophylaxis against several AIDS-diagnostic diseases has been recommended. In order to detect the impact of these measures we analyzed the shifts in the spectrum of AIDS-diagnostic diseases in Spain.
Patients and methods: AIDS cases (CDC-1987) among patients over 12 years of age diagnosed in Spain during the period 1988-1993 were studied. Number and percentage of annual AIDS cases corresponding to each reported AIDS-diagnostic disease were analyzed. Annual percentage trends were assessed by means of chi 2 trend test and logistic regression adjusting for possible changes in distribution by transmission category, sex, and age-group.
Results: Annual incidence in most of AIDS-defining diseases rose over the period 1988-1993, although the proportion of cases in which the respective conditions appeared as AIDS-diagnostic diseases exhibited declining trends (p < 0.05) in: invasive candidiasis, Herpes simplex virus infection, isosporidiasis, Pneumocystis carinii pneumonia, extrapulmonary tuberculosis, Salmonella (non-typhoid) septicemia, HIV encephalopathy and wasting syndrome. Increases were observed in the proportion of Mycobacterium avium complex disease and progressive multifocal leukoencephalopathy (p < 0.05).
Conclusions: Some shifts in the spectrum of diseases are noted, which could be due to primary prophylaxis. Efforts should be targeted to improve coverage and compliance, and to develop guidelines of prophylaxis against the remaining diseases.