The Body Covers: The 5th Conference on Retroviruses and Opportunistic Infections
The Impact of HAART on Rates and Types of Hospitalizations
February 2, 1998
Poster session abstracts 179-184, 198, 205-206, 257The impact of HAART on rates and types of hospitalizations was addressed by numerous groups in the US, Canada and Europe. Viewed together, these studies reported a 50% reduction in hospitalization rates and in specific OI incidences. Some studies also reported a sharp reduction in in-hospital mortality as well.
Forrest (#179) reporting on experience in Vancouver, found that between 1994 and 1996, rates per 1000 patient days decreased for KS (from 16 to 2), PCP (from 28 to 8) and other OIs (from 60 to 8). The decrease was seen for both prophylaxis preventable (e.g., PCP) and non-preventable (e.g., KS, wasting) conditions.
The UCSF experience was reported by Holtzer (#183). They reported similar decreases between 1994 and 1997 in a well-defined group of patients: PCP incidence was down 71%, CMV incidence was down 94%, and MAC incidence was down 84%.
A decline in mortality was noted by several researchers (posters #180, #184, #198). For example, the HIV Outpatient Study (HOPS), led by the CDC and investigators in Chicago (#198) described a decrease in mortality among approximately 1700 prospectively followed patients, from 29.5 deaths per 100 patient years per quarter in 1995 to 8.8 deaths per 100 patient years per quarter in 1997.
Lower rates of bacterial pneumonia were reported by several investigators (posters #182, #184, #205). For example, Paul (#205) and colleagues noted that the incidence of bacterial pneumonia (PCP), the most common reason for hospitalization among AIDS patients, decreased by 50% from 1995 to 1997 at New York Hospital.
The possible explanation for this drop was shown by work from Morris and colleagues (#170). They studied B-cell function in patients receiving HAART and found a decrease in B-cell hyperactivity, with a significant return toward normal function. Thus, the decrease in rates of PCP which exploits B-cell rather than T-cell dysfunction, may be related to this effect.
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