CHANGES IN THE SPECTRUM OF DISEASES IN PA TIENTS HOSPITALIZED WITH HIV-INFECTION

BACKGROUND: Infections in subjects with HIV-1 infection are a frequent cause of hospital admission. Knowledge of the entities which most oft en motivate hospitalization may aid in designing the most appropriate diagnostic and prophylactic strategies. The causes of hospital admissi on in individuals with risk practices for HIV-1 infection attended in a Department of infectious Diseases in Madrid over a period of 4 years were analyzed. METHODS: The records of the patients admitted from 198 9 to 1992 were retrospectively reviewed. The principal and associated diagnoses which led to hospitalization were considered. The admissions of the two years were compared. RESULTS: Bacterial pneumonias were th e principal cause of hospitalization in the 2 years studied. Forty-fiv e percent of the infections leading to hospital admission were not inc luded among those defining AIDS. Tuberculosis was the most frequent op portunistic infection. Admissions due to pulmonary pneumocystosis, tub erculosis, toxoplasmosis, esophageal candidiasis and Kaposi's sarcoma decreased from 1989-1992. To the contrary, disseminated Mycobacterium avium complex infection and systemic infection by cytomegalovirus sign ificantly increased over the same period. The incidence of other disea ses such as endocarditis or leishmaniasis remained stable. More than h alf of the diseases were diagnosed in association with another entity during the same admission. Likewise, an increase in atypical forms of infections thus making diagnosis and treatment more difficult was obse rved. The first cases of multiresistent tuberculosis, all of rapidly f atal evolution, were identified in 1992. Mean hospital stay increased 30 % and the rate of mortality was of 9 % in 1989 and rose to 20 % in 1992.CONCLUSIONs: The spectrum of infections which led to hospital adm ission of patients with HIV-1 infection has significantly modified ove r the last 4 years being related with the generalization of prophylact ic medication for some opportunistic infections, the improvement of ce rtain diagnostic techniques and more frequent ambulatory treatment of some diseases. The mean length of stay and hospitalary mortality have increased in the HIV+ population.