Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

862 Abstracts 42440-42445

12th World AIDS Conference

42440 Changing patterns of HIV patients management:
Consequence of new antiviral strategies
Philippe Henrivaux1, Yvette Fairon2, Ginette Dubois1, Lydia Mohen1. 'Les
Cliniques St Joseph-Medecine Interne-Hematologie-SIDA Rue de Hesbaye, 75 a
4000 Liege; 2Private Contribution Liege, Belgium
Objective: To describe the evolution of our clinical practice in the HIV field
regarding the influence of the new antiviral drugs and strategies.
Methods: We reviewed the evolution of the activities of the day care unit (patient moderately to severly ill) and of the out-patients consultations (HIV+ persons
no- or slightly ill).
Results: The activity of the day care unit dropped from 1600/year in 1993
to 347/year in 1997. The out-patients visits increased from 750/year in 1993 to
1637/year in 1997.
Conclusions: We observed a shift of our medical activity in favor of the outpatients management. These informations are of nature to encourage therapeutic
compliance, to permit a reduction of hospital admissions costs and to suggest the
interest facilitating the availability of antivirals.
42441 Evaluation of HIV-infected patients on an emergency
room
Pilar Ramon', Maria Velasco Arribas2, R. Jimenez Rodriguez-Madridejos2,
J. Pardo Moreno2, E. Perez-Cecilia2, J. Sanchez-Portocarrero2. 1C/San Isidro
Labrador 8 28005 Madrid; 2MD Hospital Universitario San Carlos, Madrid, Spain
Introduction: Among the patients seeking medical attendance in the emergency
room (ER), the proportion of HIV infected patients (HIV+) ranges from 1 to 15%
according to different studies.
Objectives: To evaluate the clinical characteristics of HIV-infected patients
seeking medical attention in the ER of a tertiary hospital (1650 beds) in an
urban area in Madrid (Spain), and to assess the proportion of patients requiring
admission to the hospital.
Methods: Patients with known HIV positive serology in the ER of the Department of Medicine were prospectively included for a three month period (December
1996 to February 1997). Data about risk practices, clinical symptoms and final
decision about admission were collected.
Results: During the study period, 15.456 patients were attended at the ER,
and 204 of them were HIV+ (seroprevalence of 1.32%). Sex distribution in HIV+
patients was as follows: 72% males and 28% females, with a mean age of 34.3
~ 6.8 years. Concerning risk practices, 134 were present or past drug abusers
(81.9%), 23 were homosexual (14.1%) and 15 had heterosexual risk practices
(7.4%). Six patients did not know the way of infection, and data were not obtained
in 41 cases. Respiratory symptoms were the main medical complaint in 46.7%
of cases, followed by cutaneous lesions in 10.3%. Among HIV+ patients, 37.8%
were finally admitted to the hospital, as compared to a 15.1% of non HIV+ (p <
0.0001, x2 test).
Conclusions: ER is visited by a high number of HIV positive patients. Most
of them are drug abusers. They need to be admitted to the hospital in a much
higher proportion than non HIV+ patients. Given the high proportion of very sick
HIV+ requiring medical admission, the development of medical protocols dealing
with these patients at the ER would be very useful.
42442 Adherence of patients with AIDS to treatment with
antiretroviral medications: Difficulties related and
proposition of attenuating measures
Rosely Moralez Figueiredo, V.M. Sinkoc, M.C.B. Gallani, C. Tomazin,
S.M. Cavinatto, I.S.A. Assumpq.o, M.R.C. Colombrini. State University of
Campinas (UNICAMP), Rua Mogi Mirim 250 - Apt. 34, 13050-543 Campinas,
SP, Brazil
Background: Several factors contribute to the difficult that AIDS patients show
in adhere the treatment. Moreover, the substitution of the staff diminishes the
possibility of rising a therapeutic bond and a standardised information between
health professionals and patients. This study measures the incidence of errors in
drug intake, surveys the main difficulties related to the therapy give in account
by the patients, and proposes measures which facilitate the adherence to the
treatment.
Methods: 61 patients with AIDS were interviewed, surveying the routine of
medicament use, comparing with the medical prescription, and accounting the
difficulties reported. After this, an illustrative panel and a orientation diary were
elaborated in order to minimise the adhesion problem.
Results: The predominant difficulties report are the adverse reaction (47.5%)
and the quantity of medicaments (26.2%). The more frequent mistakes are the
combinations of drugs (26.2%) and the period of fasts (21.3%). The drugs which
generate more errors are DDI (19.7%) and indinavir (19.7%), but the medical
instructions are not understand by 26.2% of the patients. The prescription compliance is directed associated to the degree of formal education (H = 4.72, p
= 0.029), and to the number of drugs utilised by each patient (H = 12.27, p =

0.0005). In order to improve patient orientation, an illustrative panel was made
using the packing of each drug, its pills and necessary care. In a diary, the health
personnel transcript to the patients their medical receipt, associating it to fasts,
meals and sleep times.
Conclusions: The inaccuracy of patient adhesion to the medical receipt is
most related to number and type of the drugs used, and the education level
of the patients. The utilisation of an illustrative panel and a diary allowed the

patients have a better view of the drugs and of their routine, contributing to more
precise and uniform orientations. We also concluded that patient adhesion to the
treatment depends first on professional adhesion that educates them.
42443 Incidence and duration of inpatient hospitalizations
among persons with AIDS
Stephen Crystal', Anthony Los Asso2, Usha Samba Moort Hi1. 1 Rutgers
University, Institute for Health, 30 College Avenue, New Brunswick, NJ; 2North
Western University Inst. for Health, Evanston, IL, USA
Background: To analyze hospitalization patterns of persons with AIDS (PWAs)
in a multi-state/multi-episode continuous time duration framework.
Methods: PWAs on Medicaid were identified through a match between the
state's AIDS Registry and Medicaid eligibility files; hospital admission and discharge dates were identified through Medicaid claims. Using a Weibull event
history framework, we model the hazard of transition between hospitalized and
community spells, incorporating the competing risk of death in each of these
states. Simulations are used to translate these parameters into readily interpretable estimates of length of stay, the probability that a hospitalization will end
in death, and the probability that a non-hospitalized person will be hospitalized
within 90 days.
Results: In multivariate analyses, participants in a case-managed Medicaid
waiver program offering case management and home care experienced shorter
stays, older PWAs experienced hospital admissions at a lower rate but were
hospitalized for longer periods; black respondents experienced more admissions;
and residents of the area of the state with the highest HIV prevalence experienced
more frequent and longer hospitalizations. Waiver participation and white race
were associated with stays about a day and a quarter shorter and residence in
the state's high-HIV-prevalence area was associated with stays two days longer
than for others; hospitalizations of 55-year-olds were about eight days longer than
those of 25-year-olds.
Conclusions: Much socioeconomic and geographic variability exists both in
the incidence and in the duration of hospitalization among persons with AIDS
in New Jersey. Event history analysis provides a useful statistical framework for
analysis of these variations. Better understanding of these patterns may help
identify opportunities to replace inpatient with outpatient care, particularly for the
oldest and most-disadvantaged PWAs.
42444 Outpatients care of uninsured HIV+ patients:
A prospective cohort study in Paris, France
Pierre Chauvin1, B. Douala2, J. Sauniere2, J.C. Imbert2, A.J. Valleron1,
J. Lebas2. 11nserm U444, 27 Rue Chaligny, 75012 Paris; 2Hospital
Saint-Antoine, Paris, France
Background: In France, the entire population theoretically benefits from health
coverage. In fact a fraction of the population, that most vulnerable to HIV infection, remains excluded from the Social Security system. In 1992, for the first time
a medico-social consultation for uninsured patients was incorporated into the
outpatients clinic of an Academic hospital in Paris. Our objectives were (i) to describe the social characteristics of all the attending uninsured HIV+ patients, (ii) to
compare their progression as regards any AIDS-related disease and their access
and compliance to treatments, with those of insured HIV+ patients consulting at
the same outpatients clinic.
Design: Prospective comparative cohort study
Methods: We performed a prospective study wherein a cohort of 202 HIV+
uninsured patients was compared with a cohort of 416 HIV+ insured (control)
patients. Both cohorts were constituted of all the HIV+ patients who attended our
outpatients clinic between June 1, 1992 and the date of analysis: January 1, 1997.
Results: 95.5% of uninsured patients had no stable employment, 42.6% had
no source of income, 15.3% were homeless, 21% were IV drug abusers. 65%
were foreigners (from more than 50 different countries); most of them had legal
residence papers and had been in France for more than 3 years. Tuberculosis-free survival was almost three times shorter in the uninsured group than in
the control group (RH = 2.7, IC 95% = [1.2-5.9]). Medical compliance, access
to antiretroviral treatment and hospitalisation were identical in both groups. No
difference was observed in terms of occurence of a new AIDS-related disease
during follow-up.
Conclusions: From the moment that uninsured, socially deprived, HIV+ people
attend such a medico-social consultation, their access to care is as good as, if
not better, that of insured patients. The development of outpatients clinics offering
integrated medico-social care to HIV+ destitute patients must be a public health
priority.
42445 Outpatient hospital care of AIDS patients: An eight-year
assessment in an infectious disease unit in Abidjan, C6te
d'lvoire
Antoinette Boka-Yao. 22 BP 526 Abinjan 22, Cote d'lvoire

Objectives: To analyse AIDS care activities for ambulatory patients consulting at
a large teaching hospital.
Design: Retrospective study.
Methods: Of all ambulatory HIV-infected patients examined in our Infectious
Disease Unit from 1988 to 1995, one third of the files were randomly selected
and analysed.