title: A new multidisciplinary home care telemedicine system to monitor stable chronic human immunodeficiency virus-infected patients: a randomized study.
abstract: BACKGROUND
  Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals.
  
  
  METHODS
  We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out.
  
  
  RESULTS
  Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels >90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care.
  
  
  CONCLUSIONS
  Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection.
  
  
  BACKGROUND
  Clinical-Trials.gov: NCT01117675.
authors.affiliation: Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain. aleon@clinic.ub.es
authors.forename: Agathe
authors.initials: A
authors.lastname: León
authors.forename: César
authors.initials: C
authors.lastname: Cáceres
authors.forename: Emma
authors.initials: E
authors.lastname: Fernández
authors.forename: Paloma
authors.initials: P
authors.lastname: Chausa
authors.forename: Maite
authors.initials: M
authors.lastname: Martin
authors.forename: Carles
authors.initials: C
authors.lastname: Codina
authors.forename: Araceli
authors.initials: A
authors.lastname: Rousaud
authors.forename: Jordi
authors.initials: J
authors.lastname: Blanch
authors.forename: Josep
authors.initials: J
authors.lastname: Mallolas
authors.forename: Esteban
authors.initials: E
authors.lastname: Martinez
authors.forename: Jose L
authors.initials: JL
authors.lastname: Blanco
authors.forename: Montserrat
authors.initials: M
authors.lastname: Laguno
authors.forename: Maria
authors.initials: M
authors.lastname: Larrousse
authors.forename: Ana
authors.initials: A
authors.lastname: Milinkovic
authors.forename: Laura
authors.initials: L
authors.lastname: Zamora
authors.forename: Neus
authors.initials: N
authors.lastname: Canal
authors.forename: Josep M
authors.initials: JM
authors.lastname: Miró
authors.forename: Josep M
authors.initials: JM
authors.lastname: Gatell
authors.forename: Enrique J
authors.initials: EJ
authors.lastname: Gómez
authors.forename: Felipe
authors.initials: F
authors.lastname: García
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000628:therapy* / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D008297:Male; D059039:Standard of Care; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D019562:Viral Load