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HIV-related admissions to a district general hospital in the U.K.: a single centre study
Udaya P Udayaraj1, Alan Tang, Emma Vaux
1Royal Beerkshire Hospital, London Road, Reading.
Insights
Late diagnosis of HIV in immigrant populations leads to severe illness and high mortality rates. Targeted screening programs are crucial for early detection and improved outcomes in these vulnerable groups.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- HIV remains a significant global health concern, particularly impacting migrant populations.
- Late diagnosis of Human Immunodeficiency Virus (HIV) infection is associated with advanced disease and poorer prognoses.
- Understanding the characteristics of HIV-admitted patients is vital for resource allocation and intervention strategies.
Purpose of the Study:
- To analyze patient and disease characteristics of adults admitted with HIV-related illnesses.
- To assess the cost implications and short-term outcomes of inpatient HIV care.
- To identify factors contributing to late diagnosis and high mortality among HIV patients.
Main Methods:
- Retrospective evaluation of 64 adult patients admitted with HIV-related illnesses.
- Analysis of demographic data, HIV status awareness, CD4 counts, viral loads, and AIDS diagnosis.
- Assessment of inpatient days, mortality rates, and correlation with disease severity.
Main Results:
- The majority of patients were Black Africans (65.6%) and UK immigrants (75%).
- Most patients (61%) were unaware of their HIV status upon admission, with low CD4 counts (50% <50 cells/microl) and high viral loads (48% >10(5) copies/ml).
- AIDS was prevalent (38 patients), contributing significantly to inpatient stays and mortality (23.8% in-hospital deaths, predominantly among AIDS patients with low CD4 counts).
Conclusions:
- Immigrants from high HIV prevalence countries represent a substantial portion of the inpatient HIV caseload.
- Late presentation and high in-hospital mortality are significant issues within this population.
- Screening programs must be adapted to effectively reach migrant populations for earlier HIV diagnosis and treatment.
Abstract:
This study evaluates the patient and disease characteristics, potential cost implications and short-term outcomes of 64 adult patients admitted with HIV-related illnesses. The majority (65.6%) were black Africans and 75% were immigrants to the U.K. Of the 64 patients, 61% were unaware of their HIV status at admission; 50% had CD4 count <50 cells/microl and 48% had viral load >10(5) copies/ml. Thirty-eight patients had AIDS and this accounted for 66% of the total 897 inpatient days (equivalent to 16.5-30.2 patient years of highly active antiretroviral therapy (HAART), depending on the type of HAART regimen used). Fifteen (23.8%) died in hospital, and of these 11 had AIDS and a CD4 count <200 cells/microl. Immigrants from countries of high prevalence accounted for the majority of the inpatient HIV caseload. They presented late and had high in-hospital mortality. Screening programmes to allow early diagnosis and treatment should be adapted to reach migrant populations.
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