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Analysis of the clinical complexity of people living with HIV based on the GeSIDA stratification system
Julia Barrado Cuchillo1, Adrián Valls Carbó2, María José Núñez Orantos3
1Unidad de Enfermedades Infecciosas, Hospital Clínico San Carlos, IdiSSC, Madrid, Spain.
Insights
Most people living with HIV (PLWH) on antiretroviral therapy (ART) have low complexity. However, social and clinical factors indicate subgroups needing tailored care to improve quality of life.
Area of Science:
- Public Health
- Infectious Diseases
- Chronic Disease Management
Background:
- Antiretroviral therapy (ART) has transformed HIV infection into a manageable chronic condition in developed nations.
- Patient stratification, by complexity, aids in risk assessment and tailored care for chronic diseases.
- This study examines the complexity of a large cohort of people living with HIV (PLWH) undergoing ART.
Purpose of the Study:
- To analyze the complexity of people living with HIV (PLWH) on ART using the GeSIDA stratification scale (GSS).
- To identify factors associated with varying levels of complexity in PLWH.
- To inform differentiated clinical care strategies for PLWH.
Main Methods:
- A descriptive study utilizing the GeSIDA stratification scale (GSS) was conducted.
- The GSS assesses social, behavioral, clinical, and virological factors.
- Patients were categorized into low, medium, high, or extreme complexity based on GSS scores.
Main Results:
- A cohort of 1127 PLWH on ART was analyzed.
- The majority (65.3%) were classified as low complexity.
- Higher complexity was linked to lower social support, substance use, risky behaviors, female sex, lower education, AIDS history, and poorer immunological markers (CD4 count, CD4/CD8 ratio).
Conclusions:
- The GeSIDA stratification scale (GSS) indicates that most PLWH on ART are low complexity.
- Specific clinical and social factors are associated with increased complexity in PLWH.
- Subgroup identification is crucial for developing differentiated care plans to prevent complications and enhance quality of life for PLWH.
Introduction:
Thanks to improvements in antiretroviral therapy (ART), HIV infection has become a chronic disease in developed countries. The stratification of the complexity of chronic patients is a procedure used in other diseases that allows for identifying the risk level of patients and organizing care based on their characteristics. The objective of this study is to analyze the complexity of a large cohort of people living with HIV (PLWH) on ART and in regular follow-up consultations.
Methods:
Descriptive study of complexity according to the GeSIDA stratification scale (GSS), which includes social aspects, risk behaviors, comorbidities, psychological and cognitive status, and viral control in a cohort of PLWH on ART. Patients were classified as extreme, high, medium, or low complexity based on their GSS score.
Results:
A total of 1127 patients were included, 83.7% male, with a mean age of 48 years (SD: 13.10). 65.3% had low complexity, 18.5% medium, 8.3% high, and 7.9% extreme complexity. The most determining factors for higher complexity on the GSS were lower social support, drug use and risky sexual behaviors. Female sex, lower educational level, history of AIDS, a lower CD4 count and a lower CD4/CD8 ratio were associated with higher complexity.
Conclusions:
The GSS identifies most PLWH on ART as low complexity. There are clinical factors associated with greater complexity, suggesting that there are subgroups of PLWH who should receive differentiated clinical care to prevent complications and improve their quality of life.
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