Clinical, epidemiological and natural history study of HIV-1 infection among seropositive homo/bisexuals in Israel, 1986-92. A collaborative study in three medical centers.

The clinical and epidemiological aspects of HIV-1 seropositive homo/bisexuals at three AIDS screening clinics in Israel were analyzed retrospectively for the 4-year period 1986-92. Of 1,526 individuals who attended the clinics a total of 238 (15.5%) were found to be HIV-1 seropositive; 182 seropositives were followed for a mean of 3.3 (+/- 2.6) person-years. The incidence of AIDS in this cohort was 33% over 4 years, a rate of 9.8/100 person-years. Half of all HIV-1 seropositives are estimated to have been infected outside Israel. On initial presentation 144 (62%) were asymptomatic and 94 (38%) were symptomatic. CD4 levels were > 500 ml3 in 87 (36%), 200-500 ml3 in 66 (28%) and < 200 ml3 in 45 (19%) individuals. The pattern of clinical presentations was similar to that seen in the West, but mycobacterial infections were rare. A cohort of 86 homo/bisexuals with full-blown AIDS was followed for a mean of 2.2 person-years. The mortality rate in this group was 53.5% over 4 years, a rate of 26/100 person-years. Thus, HIV infection among Israeli homosexuals ceased to be a rarity as it took the pattern of AIDS in the West, with some special features such as the late presentation of patients for medical treatment and the paucity of mycobacterial diseases complicating the disease.