[Cause of hospitalization in patients with human immunodeficiency virus infection in a rural area. Role of chronic liver disease].
OBJECTIVE
To investigate whether the use of highly active retroviral therapy (HAART) has resulted in changes in the causes of hospitalization in human immunodeficiency virus (HIV)-infected patients and to assess the influence of hepatitis C virus (HCV) infection in this population.


METHODS
The causes of hospitalization in HIV-infected patients in our center were retrospectively studied according to two time periods: 1 January 1994 to 31 December 1997 (group 1, no patients treated with HAART) and 1 January 1998 to 30 June 2001 (group 2, 63% of patients treated with HAART). Epidemiological, virological and immunological parameters, and HCV infection data were studied.


RESULTS
As compared to patients in group 1, patients admitted to the hospital in group 2 were older (34.7 +/- 6.3 versus 30.6 +/- 4.6 years, P = 0.0037), had a higher CD4+ lymphocyte count (256 +/- 243 versus 146 (178, P = 0.044) and their hospital stays were significantly lower (7.7 +/- 6.3 versus 17.5 +/- 16.7, P = 0.003). Moreover, the percentage of hospitalizations for AIDS-defining diseases was lower (29% versus 50%, P = 0.046) and the percentage of hospitalizations for decompensated liver disease was higher (22% versus 0%, P = 0.007) in group 2. Among patients who died during hospitalization, there was a higher frequency of low CD4+ lymphocyte counts (77.8% versus 43.3%, P = 0.05), active HCV infection (100% versus 57.9%, P = 0.02) and AIDS-defining disease or decompensated liver disease as the cause of hospitalization (81.8% versus 45%, P = 0.02) than among survivors. Low CD4+ lymphocyte count was independently associated with mortality (OR 1063.1; 95% CI 1.3-838855.5).


CONCLUSIONS
Since the introduction of HAART in our setting, the frequency of opportunistic infections has decreased and the frequency of decompensated liver disease has increased among the causes of hospitalization in HIV-infected patients.
Rodríguez-Vidigal
Francisco F
FF
Servicio de Medicina Interna, Complejo Hospitalario Llerena-Zafra, Badajoz, Spain.franciscof.rodriguez@hllz.ses.juntaex.es
Habernau
Alicia
A
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D002908:Chronic Disease; D015897:Comorbidity; D003953:Diagnosis-Related Groups; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000187:drug effects; D008107:Liver Diseases / Q000453:epidemiology*; D008297:Male; D012189:Retrospective Studies; D012424:Rural Population; D013030:Spain / Q000453:epidemiology
D019380:Anti-HIV Agents