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Hospitalization in HIV in Chicago
Renslow Sherer1, Joseph Pulvirenti, Kim Stieglitz
1CORE Center, Cook County Hospital, Rush Medical College, Chicago, Illinois, USA. rsherer@hektoen.org
Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)
|August 29, 2003
Summary
HIV hospitalizations decreased in the highly active antiretroviral therapy (HAART) era but remained frequent, particularly among minority populations. Targeted programs for high-utilizing patients could reduce readmissions and improve outcomes.
Area of Science:
- Public Health
- Infectious Diseases
- Health Services Research
Background:
- Highly active antiretroviral therapy (HAART) has reduced HIV morbidity and mortality, but its impact on hospitalizations in urban minority populations in public sector settings is not well understood.
- Characterizing hospitalization patterns is crucial for resource allocation and targeted interventions.
Purpose of the Study:
- To identify factors associated with hospitalization among HIV-infected patients in an urban public hospital setting during the early HAART era.
- To analyze trends in HIV-related hospitalizations and their correlates.
Main Methods:
- Retrospective analysis of clinical and administrative data from an urban public hospital HIV clinic (1997-1998).
- Inclusion of 2,647 HIV-infected patients, examining demographics, insurance status, CD4 T cell counts, viral load, and hospitalization records.
Main Results:
- Hospitalizations declined from 1997 to 1998, but remained frequent, affecting 25% of patients.
- African-Americans and Hispanics experienced significantly more and longer hospitalizations than whites.
- Lower CD4 T cell count, higher viral load, older age, and lack of HAART predicted hospitalization risk.
- Unexpectedly high hospitalization rates were observed in patients with very high CD4 counts (>500 cells/mL) and very low viral loads (<500 copies/mL).
- Regular care was associated with more frequent hospitalizations.
Conclusions:
- HIV-related hospitalizations were common in the early HAART era and decreased over time.
- Predictors included older age, lack of HAART, lower CD4 count, higher viral load, and minority race.
- A subset of patients accounted for a disproportionate number of hospitalizations, suggesting potential for targeted interventions to reduce recidivism.