AEGiS-14IAC: Declining morbidity and mortality among patients with AIDS living in a nursing home.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Declining morbidity and mortality among patients with AIDS living in a nursing home.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. C10683)

Lodesani C, Guaraldi G, Righi E, Orlando G, Beghetto B, Nardini G, Bedini A, Bolzon R, Bertelli R, Cavazzi F, Esposito R
Universita di Modena, Modena, Italy

BACKGROUND: The introduction of combination antiretroviral therapy including protease inhibitors has led to a dramatic decline of mortality rates among people infected with HIV-1. Our work focuses on the changing pattern of morbidity and mortality of AIDS people living in a nursing home. The aim of this study was to examine mortality in a group of 87 prospectively followed AIDS patients living in a nursing home in the period 1991 - 2002 and to realize whether the changing mortality rates could be attributed to the introduction of new treatment regimens.

METHODS: A prospective, observational, cohort study was conducted at a nursing home in Modena. Information were collected from patients' case notes and interviews and recorded on a standard data-collection form at baseline and every 6 months thereafter

RESULTS: 102 HIV-1-infected patients living in the nursing home were selected. 87 out of them had clinical AIDS on admission. 76% were male, 24% female. The most represented age group was 30-39 years. Female patients tended to be younger than male ones. Kaplan-Meyer analysis of survival of all AIDS patients in relation to treatment is shown in the figure. A median survival time of 5 years was found in the group of patient under HAART when admitted at the nursing home. Stratification of patients according to CD4+ cell count at admission did not modify the results. Conclusion A substantial decrease in mortality and morbidity among AIDS patients living in an Italian nursing home was seen in the past 12 years. Although numbers are small, our data have mirrored the results of larger epidemiological studies like the EuroSIDA or the Swiss cohort. Statistical analyses showed that the reduction in mortality could be mostly attributed to the introduction of HAART. In the study period, increase in survival implied many changes in the care of people with AIDS. Hospice turned into nursing home and palliative care into rehabilitation. [Image not included]

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Morbidity, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, HIV-1, Cohort Studies, Incidence, Nursing Homes, Cause of Death, Survival Rate, Epidemiologic Studies, Female, Male, Human, mortality, epidemiology

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C10683