Pharmacotherapy of Hospitalised HIV-Infected Patients
Pharmacotherapy of Hospitalised HIV-Infected Patients
Objective: To describe the changes over time in drug therapy (antiretroviral as well as co-administered drugs) in HIV-infected patients who required hospital-isation during the period 1990-2001. In addition, we wanted to evaluate and compare the characteristics of these patients.
Design/setting: Retrospective review of hospitalisations of HIV-infected patients in a general hospital.
Results: During specified periods in 1990, 1997 and 2001, 22 patients out of 130 outpatients, 29 out of 394 outpatients, and 19 out of 570 outpatients, respectively, who were treated at the outpatient clinic were admitted 30, 38 and 27 times, respectively. The mean duration of these hospitalisations was 18.8, 14.2 and 16.7 days, respectively. The percentage of women and the mean age of the hospitalised patients increased over the studied time period. AIDS-related diagnoses decreased when comparing 1997 with 2001. The type of co-administered drugs of patients who required hospitalisation was fairly stable, but the total volume (defined as the mean volume of drugs per patient per bed-day) increased dramatically from 5.3 in 1990 to 6.8 in 1997 and to 15.5 in 2001. Dual and triple antiretroviral therapy decreased and became quadruple or greater therapy when 1997 and 2001 were compared. In addition, the number of hospitalised patients not treated with antiretroviral drugs increased from 1997 to 2001.
Conclusion: The incidence of hospital admissions decreased but the volume of co-administered drugs increased from 1990 to 2001, suggesting extensive comorbidity in the patients who still require hospitalisation.
Since 1987, the year in which the nucleoside reverse transcriptase inhibitor (NRTI) zidovudine was licensed, a large number of new antiretroviral drugs have become available. With the increase in the class of NRTIs, and the introduction of two new classes since 1996, i.e. the protease inhibitors (PIs) and the non-nucleoside reverse transcriptase inhibitors (NNRTIs), combination therapy became the cornerstone of treatment in HIV-1 infection. This combination therapy, now described as highly active antiretroviral therapy (HAART), has resulted in a striking decrease in morbidity and mortality. Several studies have demonstrated the shift in healthcare resource use from inpatient to outpatient services, which could be explained by the introduction of HAART. Although the use of HAART has been proven effective, patients still have health problems that need to be dealt with. Opportunistic infections, malignancies, drug dependence, psychiatric disorders or hepatic disease and many other complications may occur and may require hospitalisation.
In this study, we wanted to describe the changes over time in the composition of drug therapy (antiretroviral as well as co-administered drugs) during hospitalisation during specified periods in 1990, 1997 and 2001. In addition, we wanted to evaluate and compare the characteristics of these HIV-infected patients.
Objective: To describe the changes over time in drug therapy (antiretroviral as well as co-administered drugs) in HIV-infected patients who required hospital-isation during the period 1990-2001. In addition, we wanted to evaluate and compare the characteristics of these patients.
Design/setting: Retrospective review of hospitalisations of HIV-infected patients in a general hospital.
Results: During specified periods in 1990, 1997 and 2001, 22 patients out of 130 outpatients, 29 out of 394 outpatients, and 19 out of 570 outpatients, respectively, who were treated at the outpatient clinic were admitted 30, 38 and 27 times, respectively. The mean duration of these hospitalisations was 18.8, 14.2 and 16.7 days, respectively. The percentage of women and the mean age of the hospitalised patients increased over the studied time period. AIDS-related diagnoses decreased when comparing 1997 with 2001. The type of co-administered drugs of patients who required hospitalisation was fairly stable, but the total volume (defined as the mean volume of drugs per patient per bed-day) increased dramatically from 5.3 in 1990 to 6.8 in 1997 and to 15.5 in 2001. Dual and triple antiretroviral therapy decreased and became quadruple or greater therapy when 1997 and 2001 were compared. In addition, the number of hospitalised patients not treated with antiretroviral drugs increased from 1997 to 2001.
Conclusion: The incidence of hospital admissions decreased but the volume of co-administered drugs increased from 1990 to 2001, suggesting extensive comorbidity in the patients who still require hospitalisation.
Since 1987, the year in which the nucleoside reverse transcriptase inhibitor (NRTI) zidovudine was licensed, a large number of new antiretroviral drugs have become available. With the increase in the class of NRTIs, and the introduction of two new classes since 1996, i.e. the protease inhibitors (PIs) and the non-nucleoside reverse transcriptase inhibitors (NNRTIs), combination therapy became the cornerstone of treatment in HIV-1 infection. This combination therapy, now described as highly active antiretroviral therapy (HAART), has resulted in a striking decrease in morbidity and mortality. Several studies have demonstrated the shift in healthcare resource use from inpatient to outpatient services, which could be explained by the introduction of HAART. Although the use of HAART has been proven effective, patients still have health problems that need to be dealt with. Opportunistic infections, malignancies, drug dependence, psychiatric disorders or hepatic disease and many other complications may occur and may require hospitalisation.
In this study, we wanted to describe the changes over time in the composition of drug therapy (antiretroviral as well as co-administered drugs) during hospitalisation during specified periods in 1990, 1997 and 2001. In addition, we wanted to evaluate and compare the characteristics of these HIV-infected patients.