A recent BC Centre of Excellence in HIV/AIDS (BC-CfE) study observed trends among HIV-positive patients admitted to St. Paul’s Hospital between 2005 and 2014, finding respiratory infections and opportunistic infections were the top discharge diagnoses. In addition, the data show that, as patients with HIV are living longer lives, they are becoming susceptible to illnesses affecting the aging population in general. This is in keeping with previous BC-CfE research showing deaths among HIV-positive individuals are increasingly attributed to non-AIDS related illnesses.
Due to advances in treatment and the implementation with support of the provincial government of Treatment as Prevention¨ in B.C., providing immediate and full access to antiretroviral therapy, the number of AIDS cases has drastically decreased since the disease first emerged in the 1980s.
“The data show the benefits of implementing Treatment as Prevention¨ on the longevity and quality of life of those living with HIV,” said Mark Hull, Researcher at the AIDS Research Program, a collaboration between St. Paul’s Hospital and UBC, and Medicine Attending at the 10C AIDS Ward, a collaboration between the BC-CfE and Providence Health Care. “The data found, over time, more people in the study were on antiretroviral therapy and this corresponded to higher CD4 counts and higher rates of suppressed viral loads. However, further study is required on the factors associated with illnesses such as respiratory infection and recurrent pneumonia.”
The study was based on data from the 10C Ward clinical database and the Drug Treatment Program database. This May 27 marks one year since the 10C Ward was repurposed due to a decline in AIDS cases. Located on the 10th floor of St. Paul’s, the ward shifted to address the increasing demand for the management of infections among patients with addictions; however the admissions policy remains preferential to those who are living with HIV.
The top discharge diagnoses observed for patients in 10C were for respiratory infections (18.2%) followed by opportunistic infections (10.7%). Other diagnoses included cellulitis or bacterial infection of the skin (6.5%), gastroenteritis (6.3%), endocarditis and blood infections (4.9%), obstructive lung disease (3.0%), liver disease (2.7%), and hematologic malignancy (2.2%). Patients aged 50 or older were more likely to receive diagnoses often seen in an aging population including obstructive lung disease, liver disease and hematologic malignancies. AIDS-defining malignancies remained low as a percentage of diagnoses over time.