Impact of combination therapy for HIV infection on inpatient census

An Integrated “Care Path” Approach: Useful for Implementation and Coordination of New Care Guidelines for Treatment of HIV Infections

Recently, the 1997 revised guidelines were published for the treatment of HIV-infected patients. These guidelines, while having a dramatic effect on the morbidity and mortality associated with HIV infection, will require the implementation of a coordinate interdisciplinary “Care Path” for each patient. This review presents updated information on the HIV life cycle and the latest approach to antiretroviral therapy. The new approach to therapy is to utilize combination antiretroviral therapy including two retroviral inhibitors with a protease inhibitor. Further, the importance of viral load has become a primary indicator of prognosis and therapy efficacy. The CD4 cell count is important, but it is of secondary significance in treatment effectiveness measurement and indication of disease progress. The complexity of the new guidelines increases the need for a well-planned interdisciplinary “Critical Path” which is then utilized for development of a patient-specific “Care Path.”

Impact of protease inhibitors on AIDS-defining events and hospitalizations in 10 French AIDS reference centres. Fédération National des Centres de Lutte contre le SIDA

OBJECTIVE

To assess the clinical and economic consequences of the use of protease inhibitors in the treatment of HIV infection.

DESIGN

Multicentric, observational, retrospective cohort study.

SETTING

Ten AIDS reference centres in France.

PATIENTS

All patients followed in each centre from September 1995 through October 1996.

MAIN OUTCOME MEASURES

AIDS-defining events, death, health-care resources use, administration of antiretroviral therapy.

RESULTS

Data from 7749 patients in 10 centres showed a drop in hospitalization days by 35%, new AIDS cases by 35%, and deaths by 46%. In the same period, the proportion of patients receiving antiretrovirals rose from 36 to 53% including highly active antiretroviral therapy (HAART), which rose from 0.3 to 18%. Overall cost evaluation showed a slight increase of monthly treatment cost of US$ 12 per patient. Comparison of the three centres that used HAART earliest to the three centres that used it latest showed a clear benefit to early HAART with a drop in hospitalization days by 41%, new AIDS cases by 41% and deaths by 69%. The proportion of patients with HAART rose to 27% and monthly health-care cost decreased by US$ 248852 (i.e., by US$ 101 per patient per month). Late prescribing centres experienced a less marked effect with a drop in hospitalization days by 22%, new AIDS cases by 31%, and deaths by 32.5%. Proportion of patients with HAART rose to 12% and monthly health-care costs increased by US$ 113578 (i.e., by US$ 38 per patient per month).

CONCLUSIONS

This study supports the extensive use of HAART in HIV-infected patients.