Incidence, reasons, and risk factors for hospital admissions in patients starting their clinical management in the era of combination antiretroviral therapy
Abstract number: 1733_150
Tone A., Viget N., Choisy P., Baclet V., Ajana F., Gerard Y., Melliez H., Mouton Y., Yazdanpanah Y.
Objective: To assess the incidence and reasons for hospital admissions and to determine factors associated with hospitalisation in a French clinical cohort of HIV-infected patients
Methods: We conducted our study on HIV-infected patients from the Tourcoing AIDS Reference Center who started their clinical management from January, 1997 to August, 2004 and followed through December, 2004. We categorised diagnoses into seven disease groups. Time to hospital admission was calculated using the Kaplan-Meier method, from enrolment to the first admission. A multivariate Cox model was used to determine independent risk factors for hospital admission among demographic, clinical and laboratory characterises of patients at the inclusion.
Results: Among 781 patients followed for a median period of 2.9 years (IQ2575, 1.35.3), 325 patients (41.6%) experienced at least one hospital admission, 179 (22.9%) at least two admissions, and 112 (14.3%) at least three admissions. The risk for the hospital admission was estimated at 33.2%, 39.3%, and 43.9% at one, two, and three years after enrolment, respectively. The most common reasons for hospitalisation were AIDS defining illness (26.3%), non AIDS-defining infections (16.7%), neoplasms (14.3%)and toxic events related to treatments (10.7). The less frequents reasons for hospitalisation were the cardiovascular diseases (2.2%). In the multivariate analysis, age >50 years (vs. <30, hazard ratios [HR], 1.7; 95% Confidence Interval [95%CI], 1.12.5), initial AIDS stage (HR, 8.2; 95%CI, 6.011.1), HIV viral load >5 log copies/mL (vs. <4.5; HR, 1.4; 95%CI, 1.11.9), viral hepatitis infection (HR, 2.0; 95%CI [1.42.8), and a history of mental illness at enrollment (HR, 1.7; 95%CI, 1.22.4) were predictive of hospital admission.
Conclusion: Our data indicates that in the era of combination antiretroviral therapy, hospital admission remain substantial among HIV-infected patients. Specific interventions should target subgroups of patients at risk of hospital admission to reduce the occurrence of events for which hospitalisations are required. Given the high cost of hospital admissions, these interventions might be particularly efficient and should be prioritised.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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