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HIV-related morbidity rate, thirteen years after the introduction of highly active antiretroviral therapy (1996-2009)

Background

After the availability of combined antiretroviral therapy (cART), we quantified the consequences on the general morbidity rates, and HIV-related hospitalization rates, in the period 1992-2008.

Methods

HIV-associated hospitalizations were assessed according to three different periods of time: before cART introduction (1992-1995), immediately after first cART availability (1996-1998), and the last one, referred to the fully established cART era (1999-2008).

Results

During the three examined periods, an undetectable viremia was never detected in any patient in the pre-cART era, in 21% of cases in the first years of cART, and in 41% of patients in the last years of cART (p < .0001). In parallel, the mean CD4+ T-lymphocyte count in the three study groups tested 27.2 ± 11.3 cells/μL, 39.3 ± 14.6 cells/μL, and 89.6 ± 38.2 cells/μL, respectively (p < .001). During time, an increased frequency of hospitalization of heterosexual and female patients occurred, while the frequenct of IVDA had a significant drop (from 69% in the pre-cART period, to 57% during initial cART era, to 39% at the time of consolidated cART era; p < .0001). The patients with a prior diagnosis of full-blown AIDS represented 86%, 57%, and 33%, respectively (p < .0001), while hospitalized inpatients who experienced a diagnosis of AIDS concurrently with the first detection of HIV infection (the so-called "AIDS presenters"), showed an evident temporal increase (11%, 21%, and 39%, respectively; p < .0001). Among concurrent illnesses, a huge rise of chronic liver diseases was registered from the pre-cART time (18%), to the first years of cART availability (29%), to the current time of advanced cART (48%) (p < .001), while an increased mortality due to hematological and solid malignancies also occurred, although at a lesser extent (8.2%, 11.7%, and 17.8% respectively; p < .001).

Discussion

The introduction of cART profoundly acted on the general morbidity for HIV infection and AIDS, although the epidemiological-clinical-laboratory scenario significantly changed over time. These modifications need a careful monitoring, in order to ensure a timely diagnostic and clinical disease recognition by all involved health caregivers who face HIV-infected patients, and to plan an adequate allocation of available resources, funding, structures, and dedicated personnel.

Author information

Correspondence to Roberto Manfredi.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Keywords

  • Morbidity Rate
  • Solid Malignancy
  • Concurrent Illness
  • Health Caregiver
  • General Morbidity