TITLE

Combination therapy for HIV: the effect on inpatient activity, morbidity and mortality of a cohort of patients

AUTHOR(S)
Brettle, Ray P.; Wilson, Alan; Povey, Sarah; Morris, Sheila; Morgan, Rhoda; Leen, Clifford L. S.; Hutchinson, Sharon; Lewis, Steff; Gore, Sheila; Brettle, R P; Wilson, A; Povey, S; Morris, S; Morgan, R; Leen, C L; Hutchinson, S; Lewis, S; Gore, S
PUB. DATE
February 1998
SOURCE
International Journal of STD & AIDS;Feb1998, Vol. 9 Issue 2, p80
SOURCE TYPE
Academic Journal
DOC. TYPE
journal article
ABSTRACT
We set out to quantify the changes in HIV-related morbidity and mortality associated with the clinical use of antiretroviral therapy via prospectively collected patient-related events (admissions, bed days, deaths, WHO stage 3 and 4 events and drug costs) on all HIV patients known to the Regional Infectious Disease Unit (RIDU) from 1 January 1987 to 31 December 1996. The introduction of zidovudine monotherapy in 1987 for those with AIDS was associated with a subsequent decline of inpatient activity for 2 years: in 1989 there was a 23% reduction in bed days but only a 6% reduction in admissions. A further dramatic decline of patient-related events in those with AIDS was noted during 1996 following the introduction of combination therapy, a 39% reduction in admissions, 44% reduction in bed days, 54% reduction in stage 4 events, 33% reduction in WHO stage 3 events and 40% reduction in the death rate. Reductions were also observed for patients without AIDS including a 42% reduction in the rate of patients developing AIDS. Similar reductions were noted when the patients were classified by immunological instead of clinical status although data for 1997 suggest an increase in patient-related activity for those with CD4 counts >200 cells/microl possibly as a result of low levels of anti-HIV therapy. The introduction of combination therapy for HIV has to date led to a minimum saving of one inpatient bed per 100 patient years which helped defray the cost of combination therapy. Although we cannot imply causality from an observational study, dramatic reductions in patient-related activity were associated with the introduction of combination therapy into clinical practice. The ultimate extent and duration of this effect cannot as yet be predicted and caution is required since similar reductions were noted with zidovudine therapy which were unfortunately time limited.
ACCESSION #
22202142

 

Related Articles

  • Recurrent hypersensitivity to Combivir. Winston, Alan; McLean, Ken // International Journal of STD & AIDS;Mar2002, Vol. 13 Issue 3, p213 

    The non-nucleoside reverse transcriptase inhibitors (NNRTIs) are commonly used in combination antiretroviral therapy and are associated with hypersensitivity reactions on induction therapy. We report a case of recurrent hypersensitivity associated with Combivir, when there was a delay in...

  • Antiretroviral therapy in HIV infection: are we using resources appropriately and cost effectively? Horn, C. K.; Dodds, R.; Scott, G. R. // International Journal of STD & AIDS;Oct1999, Vol. 10 Issue 10, p689 

    The provision of antiretroviral therapy to HIV-positive patients attending the Department of Genitourinary Medicine at the Royal Infirmary of Edinburgh was assessed, to examine whether clinicians were offering treatment in line with the departmental protocol. A total of 195 patients attended in...

  • Risk of Myocardial Infarction in Patients with HIV Infection Exposed to Specific Individual Antiretroviral Drugs from the 3 Major Drug Classes: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study. Worm, Signe Westring; Sabin, Caroline; Weber, Rainer; Reiss, Peter; El-Sadr, Wafaa; Dabis, Francois; De Wit, Stephane; Law, Matthew; D'Arminio Monforte, Antonella; Friis-Møller, Nina; Kirk, Ole; Fontas, Eric; Weller, Ian; Phillips, Andrew; Lundgren, Jens // Journal of Infectious Diseases;2/1/2010, Vol. 201 Issue 3, p318 

    Background. The risk of myocardial infarction (MI) in patients with human immunodeficiency virus (HIV) infection has been assessed in 13 anti-HIV drugs in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Methods. Poisson regression models were adjusted for cardiovascular...

  • Decreased awareness of current smoking among health care providers of HIV-positive compared to HIV-negative veterans. Crothers, Kristina; Goulet, Joseph L.; Rodriguez-Barradas, Maria C.; Gilbert, Cynthia L.; Butt, Adeel A.; Braithwaite, R. Scott; Peck, Robin; Justice, Amy C.; Gibert, Cynthia L // JGIM: Journal of General Internal Medicine;Jun2007, Vol. 22 Issue 6, p749 

    Background: Cigarette smoking is an important risk factor for morbidity and mortality in HIV-positive patients on combination antiretroviral therapy.Objective: To determine whether awareness of smoking differs between HIV and non-HIV providers, and to identify factors...

  • Difference of virus populations in HIV carriers in relation to AZT treatment. Sakamoto, Takashi; Wakamiya, Nobutaka; Tochikura, Akiko; Tsuchie, Hideaki; Kurimura, Takashi; Sakamoto, T; Wakamiya, N; Tochikura, A; Tsuchie, H; Kurimura, T // International Journal of STD & AIDS;Jun1997, Vol. 8 Issue 6, p378 

    To analyse the appearance of AZT-resistant HIV in HIV carriers after AZT treatment and compare the mutations responsible for resistance employing cloned HIV DNA derived from provirus and free virions in plasma, serial blood specimens were taken before and after AZT treatment. RNA in virions in...

  • Attrition through Multiple Stages of Pre-Treatment and ART HIV Care in South Africa. Fox, Matthew P.; Shearer, Kate; Maskew, Mhairi; Meyer-Rath, Gesine; Clouse, Kate; Sanne, Ian // PLoS ONE;Oct2014, Vol. 9 Issue 10, p1 

    Introduction: While momentum for increasing treatment thresholds is growing, if patients cannot be retained in HIV care from the time of testing positive through long-term adherence to antiretroviral therapy (ART), such strategies may fall short of expected gains. While estimates of retention...

  • The Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN Study). Claudia Vellozzi; John T. Brooks; Timothy J. Bush; Lois J. Conley; Keith Henry; Charles C. J. Carpenter; E. Turner Overton; John Hammer; Kathy Wood; Scott D. Holmberg; the SUN Study Investigators // American Journal of Epidemiology;Mar2009, Vol. 169 Issue 5, p642 

    Treatment of human immunodeficiency virus (HIV) infection with highly active combination antiretroviral therapy has increased survival and shifted the spectrum of HIV-associated morbidity and mortality from opportunistic infections toward a variety of other medical conditions. The prospective...

  • When should we delay highly active antiretroviral therapy? Bangsberg, David R.; Moss, Andrew; Bangsberg, D R; Moss, A // JGIM: Journal of General Internal Medicine;Jul1999, Vol. 14 Issue 7, p446 

    Focuses on the concern about the proper initiation of highly active antiretroviral therapy (HAART) in HIV-infected patients in the United States. Problems with patient adherence to HAART; Accounts on adherence as predictor of antiretroviral success; Relationship between adherence and viral...

  • Dyslipidaemia in HIV-infected patients: association with adherence to potent antiretroviral therapy. Vergis, Emanuel N.; Paterson, David L.; Wagener, Marilyn M.; Swindells, Susan; Singh, Nina; Vergis, E N; Paterson, D L; Wagener, M M; Swindells, S; Singh, N // International Journal of STD & AIDS;Jul2001, Vol. 12 Issue 7, p463 

    Metabolic complications are being increasingly recognized among HIV-infected patients treated with potent combination antiretroviral therapies. We sought to assess the association of dyslipidaemia with adherence to protease inhibitor (PI) therapy and with the markers of clinical response to...

  • Gynaecomastia in a male patient during stavudine and didanosine treatment for HIV infection. Aquilina, C.; Viraben, R. // International Journal of STD & AIDS;Jul2001, Vol. 12 Issue 7, p481 

    We report a case of gynaecomastia developed in a HIV-seropositive man, associated with a severe lipodystrophy. We hypothesize the responsibility of stavudine and didanosine in the development of these 2 complications. If many reports suggest that the protease inhibitors may promote...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics