Reductions in admissions to hospital in people treated with HAART in South Africa?

1. Reductions in admissions to hospital in people treated with HAART in South Africa? Neil Martinson1, Guy de Bruyn1, Glenda Gray1, James McIntyre1, Mosa Mosheabela1, Michael Willie1, Paul Pronyk2 1:Perinatal HIV Research Unit, University of Witwatersrand. 2: RADAR, School of Publ,ic Health, University of the Witwatersrand, South Africa. WEPEB051 BACKGROUND Highly active antiretroviral therapy has had a major beneficial effect on mortality and morbidity of HIV infected adults and children. However, the impact of reductions in morbidity on admission rates have not been quantified in people being treated for HIV in developing settings. In South Africa over 250 000 people are treated with HAART currently. However, over 40% of all adults admission to hospital are HIV-infected. The objective of this study was to assess whether there were reductions in admission rates associated with treating HIV-infected adults with HAART. NOTE: DATA, METHODS OF ANALYSIS AND RESULTS HAVE CHANGED SINCE THE SUBMISSION OF THE ABSTRACT • METHODS • Two operational cohorts of HIV-infected adults in South Africa followed up prospectively from 2003 • Urban and a rural cohorts at Soweto and Tintswalo Hospital (Acornhoek) respectively. • Participants receive nurse based primary HIV care until eligible for ARVs that includes. • CD4 monitoring • cotrimoxazole preventive treatment if appropriate, • treatment of common HIV related illnesses, • family planning • Annual cervical smear • Isoniazid preventive treatment for 6 months is offered. • Data is scheduled to be collected every 4-7 months and continues after initiation of ARV. • At each data visit, a participants are asked about admissions to hospital and if positive dates of admission and discharge and discharge diagnoses are collected • Statistical analysis • The analysis was restricted to participants who had at least 2 data collection visits. • Participants with missing values were not included in these analysis. • Kaplan Meier survival curves (time to first admission) were calculated for • The entire group using all people irrespective of whether or not they were treated with ARVs • Restricted to those patients who were started on ARVs using their time prior to ARV therapy and their time when treated with ARVs. RESULTS The data of 2706 adults was included in this analysis which participants recruited from June 2003 and collected to the end of the first quarter of 2007 and represents 3672 person years of observation. During this time there were 402 reported admissions to yield an overall admission rate of 10.4 per 100 person years. CONCLUSION In this analysis, exposure to ARV therapy did not result in reductions in admission rates at CD4 counts of under 499 cells/mm3 . However, it appears that ARV driven improvements in CD4 reduce admissions in those receiving ARV therapy. Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, PO Box 114, Diepkloof, Johannesburg, 1864, South Africa ACKNOWLEDGEMENTS Patient care is funded by the President’s Emergency Plan for AIDS Relief, through USAID under the terms of Award no. 674-A-00-05-00003-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID. www.phru.co.za