Motivos de internación vinculados a la infección por HIV en la era pre y post-tratamiento antirretroviral de alta eficacia (original) (raw)
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HIV & AIDS Review
Introduction: Highly active antiretroviral therapies (HAART) decrease the incidence, morbidity, and mortality of acquired immunodeficiency syndrome (AIDS) dramatically. However, current research reported an increased hospitalization rate among AIDS patients. Therefore, this study aimed to determine causes and predictors of hospital admission as well as in-hospital mortality amongst human immunodeficiency virus (HIV)/AIDS-infected patients on HAART. Material and methods: This was a multi-center cross-sectional study, and included HIV/AIDS patients who were admitted to secondary and tertiary care hospitals in Oromia Regional State from May 1, 2017, to August 30, 2017. Data were collected from hospitalized HIV/AIDS patients using structured checklist and interview. Results were analyzed with Statistical Package for Social Sciences (SPSS) software, version 22. Bivariate and multivariable logistic regression analysis were performed to evaluate association, and p-value < 0.05 was used to determine relationship between dependent and independent variables. Results: Out of 171 participants enrolled, 105 (61%) were hospitalized due to opportunistic infections. Age ranged from 40 to 49 (AOR = 0.30; 95% CI: 0.09-0.98%) vs. 18-29, females (AOR = 2.41; 95% CI: 1.11-5.24%), CD4+ count less than 200 (AOR = 10.32; 95% CI: 3.49-30.52%), and poor adhered (AOR = 2.78; 95% CI: 1.21-6.41%) were significantly related to hospitalization with opportunistic infections (AIDS-related illnesses). Among admitted patients, 20 (11.7%) died in hospital. Poorly adherent patients and those who spent 9 days or more in hospital were more exposed to in-hospital death, with AOR = 3.093; 95% CI: 1.012-9.453% and AOR = 4.533; 95% CI: 1.371-14.985%, respectively. Conclusions: The major causes of hospitalization were HIV/AIDS-related illnesses. Adherence to the HIV drug regimen is warranted to minimize hospitalization with opportunistic infections and HIV/AIDS mortality.
Epidemiologia e Serviços de Saúde
Objective: to evaluate the availability of Brazilian National Health System (SUS) outpatient services for people living with HIV in Mato Grosso state, Brazil. Methods: this is an evaluative study with descriptive cross-sectional design carried out in 2016; data were collected via the HIV Services Quality Assessment System in all 15 outpatient services; data were analyzed by frequency of answers. Results: five of the 15 services had a sufficient number of physicians; antirretroviral drugs were out of stock for more than seven days in half of the services; other medications for sexually transmitted infections, opportunistic infections, Hepatitis B and C, and metabolic disorders were available in less than 1/3 of the services within the recommended timeframe. Conclusion: resources were found to be deficient in services for people living with HIV in Mato Grosso, mainly regarding the availability of professionals and drugs.
BMC health services research, 2015
The number of HIV-related hospitalizations has decreased worldwide in recent years owing to the availability of highly active antiretroviral therapy. However, the change in HIV-related hospitalizations in Portugal has not been studied. Using comprehensive hospital discharge data from mainland Portuguese hospitals, we examined trends in HIV-related inpatient admissions, length of stay (LOS), Elixhauser comorbidity measures, in-hospital mortality, and mean cost from 2000 to 2010. The hospital administrative data from inpatient admissions and discharges at 75 public acute care hospitals in the Portuguese National Health Service from 2000 to 2010 were included. HIV-related admissions were identified using the International Classification of Diseases, 9(th) Revision, Clinical Modification diagnosis codes 042.x-044.x. The effect of Elixhauser comorbidity measures on extending the LOS was assessed by comparing admissions in HIV patients with and without comorbidities using the Mann-Whitney...
AIDS Research and Human Retroviruses, 2002
Effective antiretroviral therapy initially resulted in large decreases in hospitalization rates of HIV-infected patients. The goal of this study was to determine whether these gains were being maintained in 2001. A crosssectional study of hospital admission characteristics during four time periods was performed. All patients receiving care at the HIV clinics of New York Presbyterian Hospital-Cornell Medical Center (NYPH) in New York City were included. In 1995, 883 outpatients were receiving care for HIV infection at NYPH; this increased to 1990 outpatients by 2001. Demographic and laboratory information was obtained for these outpatients, and diagnoses were recorded for all patients requiring hospitalization on at NYPH during the time pe
An evaluation of antiretroviral HIV/AIDS treatment in a Rio de Janeiro public clinic
Tropical Medicine and International Health, 2003
The Brazilian public health system has implemented free, universal access to antiretroviral (ARV) therapy for HIV-infected patients. To evaluate this system, we performed a pilot study to determine whether ARVs were prescribed according to Brazilian guidelines in place in 2000, and whether prescriptions were refilled in a timely manner. Year 2000 data were abstracted from all medical and pharmacy records of adult patients first registered for HIV/AIDS care in a Rio de Janeiro public clinic from January to June 2000 (n ¼ 67). Results were analysed using frequency analyses, chi-square tests and logistic regression. The patient sample was 41.8% female and had a mean age of 34.9 years. 54 (81%) had AIDS; total sample mean baseline CD4+/viral counts were 276 cells/mm 3 and 237 517 copies per millilitre, respectively. Delays between clinic request and receipt of first CD4+/viral load results ranged from 25 to 107 (mean 66) and 33 to 139 (mean 86) days, respectively. Fifty-nine patients (88.1%) were prescribed ARV treatment. Forty-two regimens (71.2%) were highly active antiretroviral therapies; 17 (28.8%) were combination regimens with two nucleoside reverse transcriptase inhibitors. No combinations were prescribed that were contraindicated in Brazilian guidelines, however 33 patients (55.9%) were prescribed ARV drugs before one or both HIV status parameters (initial CD4+ level or viral load) were recorded. Fourteen patients prescribed ARVs (23.7%) lacked a supply of medication for >1 month during the year at least once. Of these patients, 11 had treatment lapses as a result of failure to pick up medications, and three lacked medication because of drug shortages. Medication lapses were associated with female sex, being hospitalized in 2000, and having more than two drugs in regimen, but were not associated with age, CD4+ level or use of ARVs before 2000. The results from this pilot study suggest conservative prescription of HAART, high practitioner adherence to guidelines, and some problems with refilling medications in a timely manner. Monitoring delays were identified as a structural limitation to optimal adherence to practice guidelines. Better access to monitoring-laboratory facilities and greater drug availability would improve programme success.
Emergency department utilization by HIV-positive adults in the HAART era
International Journal of Emergency Medicine, 2008
Background No published study has analyzed emergency department (ED) utilization by human immunodeficiency virus (HIV)-positive adults in the highly active antiretroviral therapy (HAART) era. Aims The purpose of this study is to describe the demographic and HIV-specific variables associated with ED utilization by HIV-positive adults and their diagnoses when discharged from the ED or subsequently from the hospital. Methods We conducted a retrospective cohort study of all HIV-positive adults cared for at a tertiary center HIV clinic and ED (1 January-31 December 2006). Demographic, HIV clinical, and HIV lab variables were abstracted from the clinic database. ED/hospital diagnoses coded by the ICD-9 Diseases/Injuries Tabular Index were abstracted from identified discharge records. We used multivariate logistic regression to compute odds ratios (OR) of ED utilization based on the abstracted variables. We described the cohort and diagnoses using descriptive statistics. Results A total of 356 patients met inclusion criteria. Their mean age was 42.7 years, and 77.2% of included patients were male; 52.5% were Caucasian and 47.5% non-Caucasian; 72 patients (20.2%) presented to the ED during the study period [153 visits; 37 (10.4%) required hospitalization (61/153 visits)]. Income level and mean 2006 viral load had a significant association (p<0.05) with ED utilization. Of 155 ICD-9 ED discharge diagnoses, ill-defined symptoms/signs (25.2%), injury (18.7%), and musculoskeletal disorders (11.6%) were most prevalent. Of 450 ICD-9 hospital discharge diagnoses, endocrine/metabolic (13.3%), psychiatric (12.2%), infectious/parasitic (12%), and circulatory disorders (11.8%) were most prevalent. Conclusion In this study of HIV-positive adults, income level and mean 2006 viral load had a significant association with ED utilization. Noninfectious diagnoses were alone most prevalent in ED discharged, but not hospitalized, patients.
Causes of hospital admission of AIDS patients in southern Brazil, 2007 to 2012
Revista da Sociedade Brasileira de Medicina Tropical, 2014
Introduction: The acquired immunodefi ciency syndrome (AIDS) epidemic is a worldwide phenomenon that has been modifi ed with the implementation of effective antiretroviral therapy. The objective of this study was to determine the leading causes of hospitalization among human immunodefi ciency virus (HIV)-positive individuals. Methods: A cross-sectional study with patients admitted to a general hospital in southern Brazil, between January 2007 and May 2012. Results: Medical records of 550 hospital admissions (230 patients) were reviewed, with an average of 2.4 hospitalizations per patient. Infectious diseases were the most prevalent causes of hospitalization. Overall, 44.8% patients died and their deaths were associated with longer hospital stays. Conclusions: Opportunistic infections remained the leading causes of hospitalization.
Open Forum Infectious Diseases, 2019
Background The life expectancy of HIV patients has increased with antiretroviral therapy which has reduced the incidence of AIDS-associated illnesses. Longer life expectancy increases noncommunicable diseases cases and the demand for intensive care unit (ICU) care. ICU mortality is higher among HIV patients. Information about mortality and other relevant outcomes among HIV patients from developing countries is paramount for benchmarking purposes. This study aimed to evaluate the mortality of patients with HIV/AIDS admitted to the ICU during the years 1999 to 2015. Methods An observational retrospective study was conducted based on episodes of patients admitted to the ICU of the Fundación Valle del Lili from December 1998 to October 2015. The Cochran-Armitage test was used to evaluate the trend of HIV mortality by 4-year periods, considering sex and age groups ( <50 vs. >50 years). The Z test compared the mortality between HIV patients with non-HIV patients in the ICU; also it ...