Decreased morbidity and use of hospital services in English HIV-infected individuals with increased uptake of anti-retroviral therapy 1996-1997

Objective: To investigate the relationship between changing morbidity patte rns, the use of hospital services by HIV-infected patients and the uptake o f antiretroviral therapy (ART) in England. Design: Prospective serial cross-sectional analyses based on data collected through the National Prospective Monitoring System (NPMS), a multi-centre prospective monitoring system. Setting: HIV-infected patients seen in 10 clinics, five London and five non -London, during the three semesters, 1 January 1996 to 30 June 1997. Main outcome measures: The mean use of hospital services per patient-year, mean new HIV-related opportunistic illnesses per 1000 patient-years and per centage uptake of ART. Results: The use of inpatient services changed particularly among AIDS pati ents. The mean number of inpatient days for AIDS patients decreased from 19 .7 [95% confidence interval (CI) 13.7-25.7] in 1996 to 11.2 (95% CI 6.1-15. 6) per patient-year in 1997. Concurrently the number of new AIDS-defining e vents decreased significantly from 567 (95% CI 529-607) to 203 (95% CI 183- 225) per 1000 patient-years. The overall uptake of ART increased significan tly from 33% (95% CI 31-35%) to 50% (95% CI 48-52%), and a switch from mono or dual to triple therapy or quadruple or more therapy was observed. Howev er, by mid-1997 only 29% (95% CI 26-32%) of asymptomatic patients and 51% ( 95% CI 49-54%) of patients with symptomatic non-AIDS were on ART, compared with 69% (95% CI 66-71%) of AIDS patients. Conclusion: The observed reducti on in new AIDS-defining events has led to a reduction in the need for inpat ient hospital care and has been associated with an increased uptake of ART, including a switch to triple therapy. All of these factors are likely to h ave contributed to the observed reduction in mortality among English AIDS p atients. As the overall uptake of ART remained relatively low in English ce ntres further improvements can be anticipated. However, the medium to long- term effects of these treatment regimens will need to be closely monitored. (C) 1999 Lippincott Williams Le Wilkins.