Suchergebnisse

Comparison of hospital admission causes for previously known (group A) and HIV‐infected patients diagnosed during in‐ward stay (group B), from 2009 to 2011. Retrospective evaluation of demographic, epidemiologic, clinical, immunologic, virologic and treatment parameters at time of admission. 1167 patients were admitted; of those 617 (52,9%) were HIV‐infected: 92% HIV‐1 and 8% HIV‐2. 83% had previously known HIV infection and 15% were diagnosed during hospital stay (missing data in 2%). 66% were male, mean age was 46 years and 52% were Portuguese. The most frequent transmission routes were heterosexual exposure (36%) and iv drug use (29%). Mean length of hospital stay was 17 days (group A) and 28 days (group B) (p = 0,004). At admission, the mean TCD4+ count was 280 cells/mm3 in group A, and 132 cells/mm3 in group B (p<0,001). The majority of group B patients had clinical or immunological AIDS criteria at admission (84%) while group A presented a 71% rate for the same parameter (p=0,011). In group A, 52% of patients were on antiretroviral therapy but of those only 33% presented undetectable HIV plasma RNA, non‐adherence being an important cause of therapeutic failure identified in 40% of cases. Respiratory infection was the principal cause of hospital admission in both groups (33% in group A vs. 35% in group B). The most prevalent nosological entities were community acquired pneumonia in group A (18,1% vs. 11,5%‐p=0,118) and Pneumocystis jirovecii pneumonia in group B (4% vs. 18%‐p<0,001). Mycobacterium tuberculosis was frequently identified as an agent of opportunistic infection (10% in group A vs. 24% in group B‐p=<0,001). HCV coinfection was a comorbidity found in 37% in group A vs. 11% in group B (p<0,001). Other relevant comorbidities were psychiatric disturbances (16% vs. 3%‐p=0,001) and neoplastic conditions (11% vs. 0%‐p=0,001), mostly present in group A. Mortality rate was not significantly different between groups (10% group A vs. 11% group B) (p=0,773). This analysis evidenced that, a significant percentage of HIV patients diagnosed at admission were late presenters. Slightly a half of patients with previous known HIV infection were prescribed cARV and only a third presented undetectable HIV viral load. Non‐adherence was a major concern in this population. Respiratory infections had a significant clinical impact in both groups, justifying the importance of vaccination prevention strategies in immunocompromised individuals.