Human immunodeficiency virus infection at a primary care center

The incidence of HIV infection in a primary care center in Barcelona was studied and the age sex risk practices and stage of disease of the affected patients were analyzed. The center provides care for inhabitants of some of the most socioeconomically deprived districts in Barcelona. The client population is known to have high rates of tuberculosis hepatitis sexually transmitted diseases and practices at risk including intravenous drug use prostitution and promiscuity. 56 cases of HIV infection were diagnosed from 1986 through February 1989. 34 patients were male and 22 female. 4 were aged 15-19 6 were 20-24 21 were 25-29 16 were 30-34 5 were 35-39 and 4 were 4-49 years. For 26 men and 15 women intravenous drug use was the only known risk factor. Intravenous drug use was implicated in 83.9% of cases when intravenous drug users with other risk practices and partners of drug users were included. 6 cases in which sexual promiscuity was identified included 4 of heterosexual transmission in 3 prostitutes was identified included 4 of heterosexual transmission in 3 prostitutes and a frequenter of prostitutes and 2 in bisexual men. As of their most recent clinic visit 39 patients were asymptomatic carriers and 17 had AIDS. 4 were known to have died from AIDS and another from unrelated causes. 32 of the cases were diagnosed in hospitals 3 in other centers and the other 21 in the study center. In the center 22 of 26 seropositive individuals studied had some positive marker for hepatitis B. 7 of the 30 others were known to have a history of acute hepatitis. No history of syphilis was known in 26 cases and no serological studies were available. In 26 of the other 30 cases there was a history of syphilis or the serological study for syphilis was positive. 20 patients were diagnosed with tuberculosis including 8 cases of extrapulmonary tuberculosis. The true prevalence of HIV infection in the center is undoubtedly higher since no systematic screening has been done of persons with risk factors. The data for the center demonstrate the difficulty of following up HIV patients. Primary care centers would assume responsibility for care of HIV positive patients through health education of individuals with practices that place them at risk and continuous follow-up of infected patients.