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Objective : To examine the impact of age, year and region of AIDS diagnosis on early (up to 12 months) and late survival of AIDS patients in different exposure categories ; to describe the hazard pattern from 12 months after AIDS diagnosis. Patients : A total of 4577 UK adult AIDS diagnoses to the end of 1991 in men who have sex with men, 273 AIDS cases in injecting drug users, 411 AIDS patients infected by blood products, and 535 other adult AIDS cases, mainly ascribed to heterosexual transmission. Deaths have been recorded for 4739 of these 5796 AIDS patients. Results : The influence of calendar year and region of AIDS diagnosis on survival were short-term, for the most part operative only within the first year of follow-up. The monthly death-rate was roughly constant from 12 to 48 months post-AIDS [pooled estimate, 0.055 with 95% confidence interval (CI), 0.053-0.057] but was more than halved for 4-year survivors (pooled estimate, 0.022 ; 95% CI, 0.017-0.027). About 7% of AIDS cases diagnosed in 1990-1991 survive for at least 48 months. Survival after AIDS diagnosis shortens with advancing age at AIDS diagnosis : the relative hazard per decade of age (1.35 ; 95% Cl, 1.29-1.41 in the first year after AIDS) is significantly greater (P< 0.001) in the first year after AIDS diagnosis than from 12 to 48 months (1.19 ; 95% Cl, 1.13-1.25 in the second epoch). Conclusions : The influence of covariates, including age, is strongest in the first year of follow-up after AIDS diagnosis. Monthly death-rate is roughly constant at 0.055 from 12 to 48 months post-AIDS and at 0.022 thereafter.

The prison service seems to be losing its own “war on drugs.” Blood borne virus transmission1 continues despite improved access to harm reduction measures: another HIV seroconversion in a Scottish jail occurred in 1997. Moreover, the prison service has failed to meet its 1996-7 key performance indicator on drugs,2 which was for the rate of positive results from random mandatory drugs tests to be lower in the fourth quarter than in the first (in the first quarter 3269/13 594 (24.0%) of tests yielded positive results, in the fourth 24.2%). Yet the prisons' key performance indicator on drugs was always misguided, because it avoided real targets,3 such as reducing the use of opiates inside, reducing the prevalence of injecting inside, and increasing the proportion of accommodation given over to drugs free wings. The main problem is that research inside prisons is not done to outside standards and new policies are not evaluated. Scotland, and Glasgow in particular, has an injecting culture, including in prisons. At Barlinnie Prison in Glasgow, Scotland's largest prison, 15% of those tested in the …

The European Study Groups findings on Heterosexual Transmission of HIV is criticized for methodological reasons. A question is raised about how the interaction between the index patients disease and sex-related efficacy of transmission of HIV is derived. Data need to be made available on the HIV status of the contact at recruitment the sex of the contact the number of months of HIV-exposed sexual contact when the index patient had stage 1 disease the number of months of HIV-exposed sexual contact when the patient had stage 2 disease and so on. Another question pertains to prospective and past contact for those testing HIV positive and those testing HIV negative who later showed positive results. It is suggested that an improved strategy would be to consider as separate contacts those who where HIV positive at recruitment and those who had seroconversion later. Thus crude rates of seroconversion can be obtained by a comparison between HIV-exposed sexual contact of female index patients and of male index patients; i.e. 3 seroconversions of females among 135 male contacts or 2.2/100 HIV- exposed male sexual contacts; and 7 male seroconversions among 313 female contacts or 2.2/100 HIV-exposed female sexual contacts. The stage of disease is crucial and monthly exposure rates are pertinent. The data reported were insufficient to address these concerns: 159 male female index patients infected with HIV of which 16 were HIV positive at recruitment and 3 seroconverted after recruitment; and 404 female contacts of 400 male index patents infected with HIV of which 75 were seropositive at recruitment and 7 seroconverted subsequently.

Optimal dietary management of preterm infants is uncertain partly because it has been based largely on short term studies rather than on clinical outcome data. We introduce as a possible model for further trials, the structure of a large five-centre study designed to investigate dietary influences on morbidity and long term neurodevelopment, growth and clinical outcome. Currently, >600 unselected preterm infants (

In 3 of 5 collaborating centres, two clinical trials comparisons are being made between infants randomly assigned to a preterm formula (PTF) or banked milk (BBM) fed as sole diets or in conjunction with maternal milk. (n=200 at second interim analysis). BBM fed infants showed: 1. increased incidence of: severe hyponatraemia (Na 1.3, p