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In the era of highly active antiretroviral therapy, why are HIV‐infected patients still admitted to hospital for an inaugural opportunistic infection?
Author(s) -
Perbost I,
Malafronte B,
Pradier C,
Santo LDI,
Dunais B,
Counillon E,
Vinti H,
Enel P,
Fuzibet JG,
Cassuto JP,
Dellamonica P
Publication year - 2005
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2005.00282.x
Subject(s) - medicine , discontinuation , context (archaeology) , anxiety , prospective cohort study , human immunodeficiency virus (hiv) , socioeconomic status , antiretroviral therapy , pediatrics , viral load , immunology , psychiatry , population , paleontology , environmental health , biology
Objectives To identify factors related to delayed testing, and delayed or interrupted care‐seeking or treatment uptake, among HIV‐infected patients. Design HIV‐infected patients hospitalized for an opportunistic infection (OI) cases were included in a prospective study and compared with controls matched by age and sex who had regular follow‐up and treatment. Patients were asked to complete a questionnaire about their therapeutic itinerary and their socioeconomic, psychological and medical characteristics. Results Seventy patients were matched with 140 controls. According to their therapeutic itinerary prior to admission, cases were subdivided into four groups among which three will be more particularly studied: nontested patients (NT) (24%; n =17), known HIV‐infected patients with no medical follow‐up (NF) (30%; n =21); and noncompliant patients (NC) (36%, n =25). Characteristics of NT and NF patients included a predominantly sexual mode of contamination ( P= 0.01), continuing occupational activity ( P= 0.01) despite a low mean Karnofsky index ( P= 0.001) and unfavourable virological and immunological parameters. NT patients displayed a low degree of anxiety, and lacked awareness concerning risk of contamination and HIV‐related symptoms. HIV‐status announcement ( P= 0.04) and the benefits of medical follow‐up ( P= 0.05) were less favourably perceived by NF patients than by controls, and were associated with a high degree of anxiety in NF patients. NC patients had a weaker commitment to follow‐up and treatment, and more frequent treatment discontinuation associated with a higher rate of interruption of follow‐up in a context of social difficulties. Conclusions Patients ignorant of their HIV status, patients NF and NC have very specific characteristics. More appropriate approaches are needed regarding screening and access to care in order to reduce the incidence of delayed care‐seeking.