title: Ambulatory care for HIV-infected patients: differences in outcomes between hospital-based units and private practices: analysis of the RESINA cohort.
abstract: BACKGROUND
  The efficacy of highly active antiretroviral therapy (HAART) in the treatment of HIV infection is influenced by factors such as potency of applied drugs, adherence of the patient, and resistance-associated mutations. Up to now, there is insufficient data on the impact of the therapeutic setting.
  
  
  METHODS
  Since 2001, the prospective multicenter RESINA study has examined the epidemiology of transmitted HIV drug resistance in Nordrhein-Westfalen, the largest federal state of Germany by population. Characteristics of patients treated in hospital-based outpatient units were compared to those of patients treated in medical practices. Longitudinal data of all participants are being followed in a cohort study.
  
  
  RESULTS
  Overall, 1,591 patients were enrolled between 2001 and 2009 with follow-up until the end of 2010. Of these, 1,099 cases were treated in hospital-based units and 492 in private practices. Significant differences were found with respect to baseline characteristics. A higher rate of patients with advanced disease and non-European nationality were cared for in hospital units. Patients in medical practices were predominantly Caucasian men who have sex with men (MSM) harboring HIV-1 subtype B, with lower CDC stage and higher CD4 cell count. Median viral load was 68,828 c/mL in hospital-based units and 100,000 c/mL in private practices (P = 0.041). Only median age and rate of transmitted drug resistance were not significantly different. After 48 weeks, 81.9% of patients in hospital units and 85.9% in private practices had a viral load below the limit of detection (P = 0.12). A similar result was seen after 96 weeks (P = 0.54). Although the baseline CD4 cell count was different (189.5/μL in hospital units and 246.5/μL in private practices, P <0.001), a consistent and almost identical increase was determined in both groups.
  
  
  CONCLUSIONS
  The RESINA study covers a large HIV-infected patient cohort cared for in specialized facilities in Germany. Despite significant differences of patients' baseline characteristics in hospital-based units compared to medical practices, we could not find significant differences in treatment outcome up to 2 years after the initiation of HAART.
authors.affiliation: Clinic for General Medicine, Gastroenterology, and Infectious Diseases Augustinerinnen Hospital, Jakobstrasse 27-31, Koln 50678, Germany. m.oette@koeln-kh-augustinerinnen.de.
authors.forename: Mark
authors.initials: M
authors.lastname: Oette
authors.forename: Stefan
authors.initials: S
authors.lastname: Reuter
authors.forename: Rolf
authors.initials: R
authors.lastname: Kaiser
authors.forename: Björn
authors.initials: B
authors.lastname: Jensen
authors.forename: Thomas
authors.initials: T
authors.lastname: Lengauer
authors.forename: Gerd
authors.initials: G
authors.lastname: Fätkenheuer
authors.forename: Heribert
authors.initials: H
authors.lastname: Knechten
authors.forename: Martin
authors.initials: M
authors.lastname: Hower
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Sagir
authors.forename: Herbert
authors.initials: H
authors.lastname: Pfister
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011331:Private Practice; D016896:Treatment Outcome; D055815:Young Adult