Clinical and demographic features of HIV infection in El Salvador / Características clínicas y demográficas de la infección por VIH en El Salvador

OBJECTIVE: To understand some of the clinical and demographic features of the epidemic of infection by HIV in El Salvador prior to the availability of antiretroviral therapy in that country. METHODS: We conducted a retrospective review of HIV-infected individuals who were admitted to Hospital Rosales, which is a large public teaching hospital in San Salvador, El Salvador, during the 5-year period of 1994 through 1998. Chart abstraction was done of 194 out of the 208 individuals admitted to the Infectious Diseases Unit at Hospital Rosales (14 charts could not be located). We also carried out a sampling of other HIV-infected adults treated in other parts of the hospital. RESULTS: Of the 250 patients whose records we reviewed, 67 percent were men and 86 percent were from an urban area. The mean age at HIV diagnosis was 34 years. In terms of occupation, 50 percent of the men were day laborers; 76 percent of the women were housewives, and 8 percent of the women were commercial sex workers. All the women studied listed only heterosexual contact as their risk behavior. Of the men, 9 percent of them said they had sex only with men, 17 percent said with both men and women, and 65 percent said with female commercial sex workers. In terms of drug use, 2 percent of the patients reported they had used injection drugs at some point. At their initial medical visit to Hospital Rosales, over half of the 250 patients presented with a respiratory complaint or with diarrhea, 6 percent had pulmonary tuberculosis (TB), and 5 percent had extrapulmonary TB. Of the 250 patients, 177 of them (71 percent) had AIDS at the first medical visit. Of the 250, 138 of them (55 percent) were lost to follow-up. Of the remaining 112 persons, 81 of them (72 percent) were known to have died. Of those 81, 38 of them (47 percent) died of unknown causes and 21 (26 percent) died of TB. CONCLUSIONS: The HIV-infected adults treated at the Hospital Rosales during the 1994-1998 period were usually infected through heterosexual sex, were symptomatic at the time of presentation, and were often lost to follow-up. Utilizing the results of our study and of other research, efforts to expand early intervention, counseling and testing, and targeted prevention activities should be strengthened

Availability of HIV care in Central America

Central America is an area with a growing human immunodeficiency virus (HIV) epidemic, but with marked limitations in its health care infrastructure. Estimated adult HIV infection rates range from 0.20 percent in Nicaragua to 2.01 percent in Belize. Hospitals and clinicans with experience in HIV care exist mainly, if not only, in capital cities and principal economic centers. Nationally sponsored social security systems in each country consistently offer a wider range of services than do ministry of health systems. Estimated access to the social security system ranges from 0 percent in Belize and 10 percent of the population in Honduras to 95 percent in Costa Rica. Combination antiretroviral therapy is not available through the ministries of health and zidovudine is only sporadically available for prevention of perinatal transmission. Combination therapy is available through the social security system in the countries of Guatemala, Panama and Costa Rica only. A wide variety of antiretroviral agents are available through private pharmacies in all countries except Belize. With the exception of Costa Ricans, most people with HIV infection in Central America have limited access to HIV-specific health services and limited or no access to antiretroviral agents. (AU)