The aim of this thesis is to document the early natural history of HIV infection. A medical clinic for the care of HIV infected patients was established in Edinburgh in October 1985. By November 1989, 409 patients had attended this clinic and most were under regular follow up. Most patients were injection drug users (IDUs) accounting for 78% attenders, 12% were homosexual men, 7% were infected heterosexually, 1% from blood products and in 2% there were no documented risk factors. Most of the

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... s acquired HIV infection between September 1983 and June 1984 and are a unique cohort for prospective natural history studies. The other clinic attenders provide a valuable comparison group. The first four years of the clinic were chosen as the cut off point for early natural history, being six years after the introduction of HIV into the IDU population of Edinburgh. Morbidity was assessed by hospital admissions. All hospital admissions by HIV positive patients in Edinburgh were analysed. These included admissions to the designated HIV unit and to all other general and psychiatric hospitals in Edinburgh. All deaths before November 1989 were analysed, whether they occurred in hospital or at home and all post mortem results were obtained. By November 1989, 910 admissions were recorded. Although 612 of these were to the designated HIV unit, 298 were to other hospitals in Edinburgh. IDUs accounted for 702 (77%) admissions, homosexual men for 136 (15%), patients with heterosexually acquired HIV infection for 62 (7%) and recipients of blood products for 10 (1%). The most frequent admissions were for conditions directly related to drug use. These comprised overdose, trauma, injection injuries and detoxification and accounted for 220 admissions. From comparisons with published data this number is in excess of what would be expected in a historical cohort of HIV negative IDUs. Most days in hospital were used by patients with respiratory conditions (187 admissions). These were the single commonest reason for admission to the designa [...]