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Hospitalized HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy

June 2009 

Hospitalized HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy

Metsch L, et al. Am J Public Health 2009;99:1045-1049. [PubMed Abstract] 

Purpose:  To determine the reasons for hospitalization of HIV-infected patients in 2006-7. 

Method:  Interviews with 1,038 HIV-infected patients hospitalized at Jackson Memorial Hospital in Miami and Grady Memorial Hospital in Atlanta.  

Results:  The observations are summarized in the following table: 

Hospitalized patients with HIV infection

(Grady Memorial, Atlanta and Jackson Memorial, Miami) 

Population sampled 

Sample size =1038

 
>40 years oldAfrican American

Income <$5K/year

Homeless

Crack-cocaine use

Heavy alcohol

HIV known >5 years

No HIV provider in 6 mos.

Currently on ARV

71%

82%

56%

19%

34%

32%

68%

40%

42%

The results with 1,038 patients hospitalized in these two large hospitals that serve a largely underserved population show the majority were men, African American and poor with high rates of substance abuse and low frequency of provider consultation.  

Comment:  These findings will not surprise anyone in this field.  There may be criticism that the data are biased but the fact that the two large hospitals surveyed serve an underserved population in two major urban centers. Nevertheless, US data show the population sampled is pretty representative of the US patient population with HIV infection.  Data provided by Jen Kates from the Kaiser Family Foundation have shown that 74% of patients with HIV who are in care in the US are uninsured or use CMS (Medicare or Medicaid) and 45% have an annual income of less than $10,000/year.  This represents one of the major obstacles to effective HIV care delivery that is described by the authors as a patient population with “a myriad of psychosocial problems, including low socioeconomic status, substance abuse, mental health problems, unstable housing, and high rates of sexually transmitted diseases.”  They conclude that there is need for novel interventions to assure that these patients are retained in care, although the methods to do this are not at all clear.