Despite improved morbidity and mortality with the advent of highly active antiretroviral therapy (HAART), late presentation, CD4< 200 and/or an opportunistic infection or malignancy, remains a major public health concern. Although mortality causes are more diverse in the HAART era, HIV associated deaths continue to be a result of late presentation.
Carolinas HealthCare System (CHS) is a non-profit, vertically integrated healthcare system with approximately 12 million patient encounters per year. We identified new HIV positive patients from an institutional database within our multi-hospital healthcare system and retrospectively extracted clinical patient data. Patients with HIV, admitted to one of our eight acute care facilities were identified (n=1,632) from medical records, of these, 93 were diagnosed during admission.
We identified all newly diagnosed with HIV in the inpatient setting between July 2014 and March 2017 (n=93). 70% of the newly diagnosed were male, 67% identified as Non-Hispanic black and had a median age of 42 years. The median CD4 count was 156 and 76% presented with a CD4<200. Only 50% of patients were insured prior to hospitalization. Although not statistically significant in this study, we noted that those who were insured prior to hospital discharge were more likely to follow-up and have continuity of care compared to the uninsured. 42% were prescribed HAART prior to discharge. Opportunistic infections or AIDS defining malignancies were present in 38%. An OI was present in 29% with PCP being the most common and an AIDs defining malignancy was present in 9% with NHL being the most common diagnosis.. Inpatient mortality was 10% in newly diagnosed HIV patients and of those the median CD4 was 45. All of those died of AIDS related complications.
Patients in our study period presented too late in their illness with >75% presenting with a CD4<200. Our findings are limited by our small sample size and further prospective studies are needed to better identify effective strategies to prevent late diagnosis of HIV.
D. Kindlick, None