Effect of antiretroviral therapy on rehospitalization for opportunistic disease in Costa Rica
DOI:
https://doi.org/10.51481/amc.v48i4.271Keywords:
Antiretroviral therapy, HIV, AIDS, oportunistic infectionsAbstract
Aim:To characterize the hospitable debits by VIH/AIDS inthe Hospital Mexico, and to evaluate the repercussion thatthe antiretroviral therapy (ARVT) has had in the probabili-ty of re-hospitallization by opportunistic diseases in theseindividuals.
Methodology:the data of all the withdrawn patients of theHospital Mexico were compiled with HIV/AIDS diagnosisbetween January of 1995 and April of the 2003. Thedescriptive analysis of the information was made usingsoftware SPSS version 12.0 with the calculation of themeasures of central tendency and dispersion for the quanti-tative variables and calculation of the frequencies for thequalitative variables.
The calculation of the survival analysis was made by thesoftware Minitab vesión 12,2 with the definition of a statis-tical significance level of smaller or equal to 0.05. As inclu-sion criterion all the patients selected themselves who with-drew alive of their first hospitalization with the HIV/AIDSdiagnosis and divided in two groups according to the yearof their entrance and its exhibition to ARVT. The first groupcorresponds to the period of January of 1995 to Decemberde1997 and not exposed to ARVT, the individuals of thefirst period that initiated ARVT were excluded from theanalysis. The second period of 1998 to April of 2003involves the hospitable debits with HIV/ AIDS diagnosis.
Results:The data of 1081 debits corresponding to 623patients, 85,7% men were analyzed, with an average age of36,8 years, 69,8% were unmarried. The average of hospi-talizations per year was of 70,9 patients. Observed generalmortality was of 30%, but it was observed in same a tenden-cy to diminish. Only 42,5% of all the debits correspondedto direct insured.
The Kaplan Meier analysis revealed that the average todevelop a second opportunistic disease was of 466,2 days(IC95% 382.8-549.7) for the group without ARVT and of1050,5 days (IC95% 952.1-1148.9) for the group under thetherapy with significant differences between both periods(Log Rank, p<0.05). This result was influenced neither bythe basal level of CD4 nor by the basal viral load.
Conclusion:The number of hospitable debits byVIH/AIDS continues increasing. One is a young popula-tion, in his majority men, unmarried. Intrahospitablemortality is high, although it has tended to diminish. Thesurvival analysis verifies the effectiveness in our means ofthe antiretroviral therapy to diminish the occurrence of new opportunistic infections and new hospitalizations.
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References
Fauci AS. The AIDS epidemic—consideration for the 21st century. NEngl J Med. 1999; 341:1046-1050.
Organización Mundial de la Salud-ONUSIDA. Situación de la epi-demia de SIDA: 2004. Diciembre 2004.
Unidad VIH/SIDA/ITS de la Organización Panamericana de la Salud.Vigilancia del Sida en las Américas. Washington; junio 2005. pp.31
Kaposi's sarcoma and pneumocystis pneumonia among homosexualmen—New York city and California. Morb Mortal Wkly Rep 1981;30:305-308.
Vergis EN, Mellors JW. Natural history of HIV-1 infection. InfectDis Clin North Am 2000; 14:809-825.
Barré-Sinoussi F et al. Isolation of a T-lymphotropic retrovirus froma patient at risk for acquired simmune deficiency syndrome (AIDS).Science 1983; 220:868-871.
Fauci AS. HIV and AIDS: 20 years of science. Nat Med 2003; 9:839-843.
Ponerantz RJ, Horn DL. Twenty years of therapy for HIV-1 infec-tion. Nat Med 2003; 867-873.
Detels R, Muñoz A, MacFarlane G, Kingsley LA, Margolick JB,Giorgi J, et al. Effectiveness of potent antiretroviral therapy on timeto AIDS and death in men with known HIV infection duration. JAMA1998; 280:1497-1503.
Kholoud P and CASCADE Collabortion. Survival after introductionof HAART in people with known duration of HIV-1 infection. Lancet2000; 355:1158-1159.
Panel on clinical practices for treatment of HIV infection,Department of Health and Human Services. Guidelines for the use ofantiretroviral agents in HIV-1-infected adults and adolescents.October 6, 2005. pp. 118
Marins JR, Jamal LF, Chen SY, Barros MB, Hudes ES, Barbosa AA,Chequer P, Teixeira PR, Hearts N. Dramatic improvement in survivalamong adult Brazilian AIDS patients. AIDS 2003; 17:1675-1682.
OPS/OMS. Vigilancia del Sida en las Américas, Informe Bianual.Junio 2002.
Cain LE, Cole SR, Chmiel JS, Margolick JB, Rinaldo CR, Detels R.Effect of highly active antiretroviral therapy on multiple aids-defin-ing illnesses among male HIV seroconverters. Am J Epidemiol2006;163:310-315
Cameron DW, Heath-Chiozzi M, Danner S, et al. Randomised place-bo-controlled trial of ritonavir in advanced HIV-1 disease. TheAdvanced HIVDisease Ritonavir Study Group. Lancet1998;351:543-9.
Gulick RM, Mellors JW, Havlir D, et al. Treatment with indinavir,zidovudine, and lamivudine in adults with human immunodeficiencyvirus infection and prior antiretroviral therapy. N Engl J Med1997;337:734-9.
Hammer SM, Squires KE, Hughes MD, et al. A controlled trial of twonucleoside analogues plus indinavir in persons with human immun-odeficiency virus infection and CD4 cell counts of 200 per cubic mil-limeter or less. AIDS Clinical Trials Group 320 Study Team. N EnglJ Med 1997;337:725-33.
Egger M, Hirschel B, Francioli P, et al. Impact of new antiretroviralcombination therapies in HIV infected patients in Switzerland:prospective multicentre study. BMJ 1997;315:1194-9.
Mocroft A, Katlama C, Johnson AM, et al. AIDS across Europe,1994-98: the EuroSIDA study. Lancet 2000;356:291-6.
Detels R, Munoz A, McFarlane G, et al. Effectiveness of potent anti-retroviral therapy on time to AIDS and death in men with known HIVinfection duration. Multicenter AIDS Cohort Study Investigators.JAMA 1998;280:1497-503.
Nasti G, Martellotta F, Berretta M, Mena M, Fasan M, Di Perri G etal. Impact of highly active antiretroviral therapy on the presentingfeatures and outcome of patients with acquired mmunodeficiencysyndrome-related Kaposi sarcoma. Cancer 2003;98(11):2440-2446.
Organización Panamericana de la Salud-Organización Mundial de laSalud. 128a Sesión del Comité Ejecutivo. Junio, 2001.
Hellinger FJ, Fleishman JA. Estimating the national cost of treatingpeople with HIV disease: patient, payer, and provider data. J AcquirImmune Defic Syndr 2000; 24:182-188.
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