Changing conditions and treatments in a dynamic cohort of ambulatory HIV patients: The HIV outpatient study (HOPS)

PURPOSE: Most HIV-infected persons are now treated as ambulatory patients, Obtaining continually updated data about these patients' changing condition s, therapies, and reimbursement is essential to health care provision and p lanning. The systematic tracking of patient medical and laboratory informat ion in an ongoing commercial data collection program (The Health Research N etwork) allows clinicians to better understand health outcomes, practice pa tterns, and epidemiologic trends for their patients. METHODS: To evaluate trends in conditions and therapies of ambulatory HIV-i nfected patients, we analyzed such data electronically and prospectively co llected in the HIV Outpatient Study (HOPS) from 1992 through 1996 from 1876 patients seen in 11,755 clinic visits to ten HIV clinical practices. RESULTS: Patients were as likely to be diagnosed with Mycobacterium avium c omplex ([MAC] 5.4 cases per 100 person-years) or wasting syndrome (7.8 case s per 100 person-years), as Pneumocystis carinii pneumonia ([PCP]; 7.6 case s per 100 person-years) or Kaposi sarcoma ([KS]; 6.9 cases per 100 person-y ears). A nested analysis showed that HIV-iniected cigarette smokers were at substantially greater risk of pneumonia (relative hazard [RH] = 2.3), bron chitis (RH = 1.7) and hairy leukoplakia (RH = 1.9) than nonsmokers. By 1996 , 35 (56%) of 62 patients with PP, 9 (30%) of 30 patients with other pneumo nias, 28 (90%) of 31 patients with KS, 35 (73%) of 48 patients with MAC, an d 24 (63%) of 38 patients with cytomegalovirus retinitis were treated witho ut hospitalization. CONCLUSIONS: The HOPS provides continually updated information on the chang ing characteristics, conditions, and therapy of ambulatory HIV-infected pat ients. (C) 1999 Elsevier Science Inc.