Hospitalizations for HIV/AIDS: Differences between sexes

Epidemiological differences and risk factors for hospitalization in people living with HIV in Istanbul, Turkey

We aimed to determine the risk factors for hospitalization in treatment-naïve people living with HIV (PLHIV) and also the frequency of HIV-related comorbidities in hospitalized patients. Sociodemographic, clinical, and laboratory findings of treatment-naïve PLHIV followed up in our department between January 2015 and July 2018 were retrospectively evaluated and risk factors for hospitalization at initial presentation were analyzed. A total of 629 patients were included. In all, 558 patients (88.7%) were male and 326 (51.8%) were men who have sex with men (MSM), and 8.6% of all patients were hospitalized at initial presentation. When comparing outpatient and inpatient groups, the mean age (p < 0.001), rates of having heterosexual (HS) intercourse (p < 0.001), low education level (p < 0.001), late presenters (p < 0.001), and CD4 cell count < 50 cells/mm3 (p < 0.001) were significantly higher in the inpatient group. In logistic regression analysis, older age and CD4 T lymphocyte count < 50 cells/mm3 were found to be independent risk factors for hospitalization. Among hospitalized patients, 55.5% had oropharyngeal/esophageal candidiasis, 38.9% had tuberculosis, corresponding to a HIV-related comorbidity in 118 patients, among whom a mortality rate of 9.2% was detected. The rate of hospitalization was high among our patients. The majority of the hospitalized patients were HS individuals with a relatively older age who had low educational level. A lower rate of hospitalizations in a higher risk group such as MSM suggests that educational and preventive activities are required to increase awareness and to encourage HIV testing, not only in high-risk groups, but also in the general population.

Analysis of HIV/AIDS DRG in Portugal: a hierarchical finite mixture model

Inpatient length of stay (LOS) is an important measure of hospital activity, but its empirical distribution is often positively skewed, representing a challenge for statistical analysis. Taking this feature into account, we seek to identify factors that are associated with HIV/AIDS through a hierarchical finite mixture model. A mixture of normal components is applied to adult HIV/AIDS diagnosis-related group data (DRG) from 2008. The model accounts for the demographic and clinical characteristics of the patients, as well the inherent correlation of patients clustered within hospitals. In the present research, a normal mixture distribution was fitted to the logarithm of LOS and it was found that a model with two-components had the best fit, resulting in two subgroups of LOS: a short-stay subgroup and a long-stay subgroup. Associated risk factors for both groups were identified as well as some statistical differences in the hospitals. Our findings provide important information for policy makers in terms of discharge planning and the efficient management of LOS. The presence of "atypical" hospitals also suggests that hospitals should not be viewed or treated as homogenous bodies.

The influence of gender and of AIDS on the immunity of autopsied patients' esophagus

Previous studies have shown that males who have AIDS are more frequently affected by infectious diseases than females. The esophagus is the organ in the digestive tube that is more commonly affected by opportunistic infections during the syndrome. The aim of this study was to assess the influence of AIDS and of gender on local immunity of the esophageal epithelium. Fragments of the esophagus from 29 autopsied women and 37 autopsied men were collected at a university hospital from 1980 to 2009 and were divided in groups with and without AIDS. The IgA-, IgG-, and IgM-positive cells and Langerhans cells (LCs) were immunostained, respectively, with anti-IgA, anti-IgG, anti-IgM, and anti-S100. The software Image J was used to measure the esophageal epithelium and to count the epithelium cellular layers. Patients with AIDS, apart from gender, showed an increase in IgA-, IgG-, and IgM-positive cells and a reduction of Langerhans cells, in thickness and in number of cellular layers in the esophageal epithelium. However, among individuals with AIDS, men presented lower secretory expression of IgA-, IgG-, and IgM-positive cells than women and more intense reduction of LCs. Women have naturally presented better local esophageal immunity than men. Although AIDS possibly causes immunological and morphological alterations in the esophageal epithelium in both genders, women have better esophageal immunity, which may explain a greater frequency of hospital admissions due to infection of men with AIDS when compared with women.