Motivo de ingreso en pacientes infectados por el virus de la inmunodeficiencia humana en un área rural. Papel de la hepatopatía crónica

Abstract

To investigate whether the use of highly active retroviral therapy (HAART) has resulted in changes in the causes of hospitalization in human immunodeficiency virus (HIV)-infected patients and to assess the influence of hepatitis C virus (HCV) infection in this population. The causes of hospitalization in HIV-infected patients in our center were retrospectively studied according to two time periods: 1 January 1994 to 31 December 1997 (group 1, no patients treated with HAART) and 1 January 1998 to 30 June 2001 (group 2, 63% of patients treated with HAART). Epidemiological, virological and immunological parameters, and HCV infection data were studied. As compared to patients in group 1, patients admitted to the hospital in group 2 were older (34.7 +/- 6.3 versus 30.6 +/- 4.6 years, P = 0.0037), had a higher CD4+ lymphocyte count (256 +/- 243 versus 146 (178, P = 0.044) and their hospital stays were significantly lower (7.7 +/- 6.3 versus 17.5 +/- 16.7, P = 0.003). Moreover, the percentage of hospitalizations for AIDS-defining diseases was lower (29% versus 50%, P = 0.046) and the percentage of hospitalizations for decompensated liver disease was higher (22% versus 0%, P = 0.007) in group 2. Among patients who died during hospitalization, there was a higher frequency of low CD4+ lymphocyte counts (77.8% versus 43.3%, P = 0.05), active HCV infection (100% versus 57.9%, P = 0.02) and AIDS-defining disease or decompensated liver disease as the cause of hospitalization (81.8% versus 45%, P = 0.02) than among survivors. Low CD4+ lymphocyte count was independently associated with mortality (OR 1063.1; 95% CI 1.3-838855.5). Since the introduction of HAART in our setting, the frequency of opportunistic infections has decreased and the frequency of decompensated liver disease has increased among the causes of hospitalization in HIV-infected patients.