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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



NEWS AND NEW DEVELOPMENTS



Hospitalization Rates in an Urban Cohort After the Introduction of Highly Active Antiretroviral Therapy [Gebo KA et al. JAIDS 2001; 27: 143]: The authors review the experience of the Johns Hopkins Moore Clinic with 2,151 HIV-infected patients for the period 1/1/94 through 12/31/98 to determine hospitalization rates, discharge diagnosis and use of the ICU. Baseline studies showed that the mean CD4 count was 294 cells/mm3, and 50% of the participants had injection drug use as their risk. During the course of the evaluation, about 40% of the patients received HAART, and 40% received no antiretroviral therapy. Of those eligible, 87% received PCP prophylaxis, and 81% received MAC prophylaxis. The frequency of hospitalization in the pre-HAART period was 0.87/patient-year, which declined to a nadir in the first half of 1997 to .5/patient-year and then increased to .61/patient-year in the first half of 1998. Risk factors for hospitalization were female sex, injection drug use, low CD4 cell count and lack of antiretroviral therapy. There was a substantial increase in hospitalizations for non-OI medical conditions. ICU admissions applied to 5.6 % of hospitalizations.
Comment: The results of this study suggest that the substantial decline in hospitalizations noted with HAART may have already demonstrated the maximum benefit. There are some idiosyncrasies of the Moore Clinic population that deserve emphasis: The main one is that 50% of the patients are injection drug users which has a notable impact on the frequency of hospitalization for non-HIV related complications and poses great challenges for antiretroviral therapy. The authors noted a substantial reduction in hospitalizations in the early period of HAART and then a significant increase in hospitalizations that were ascribed primarily to non-OI complications. Part of this increase can be attributed to the complications of HAART (diabetes, pancreatitis, lactic acidosis, etc.), part of it to co-morbidities such as hepatitis C or mental illness, and part of it is due to complications of injection drug use.
posted 7/3/2001





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