Journal of Infection (2015) xx, 1e5
www.elsevierhealth.com/journals/jinf
LETTER TO THE EDITOR Inpatient admissions of patients living with HIV in two European centres (UK and Italy); comparisons and contrasts
Dear Sirs, In this journal Sogard and colleagues described HIV comorbidities across in a very large pan-european population. However we think there may be striking differences between individual countries in Europe,1 so we are reporting our experience. Combined antiretroviral treatment (cART) has reduced morbidity and mortality rates2 in people living with HIV (PLWH) because of fewer opportunists infections, but premature age related co-morbidities3 and increased hospitalisation still occur.4 The future impact of non-infectious comorbidities (NICMs) on patient care and service provision is still unfolding and information on current admissions may be helpful in planning future services. This article gives a description of the clinical conditions and patient demographics of inpatient admissions in two HIV specialist centres. Chelsea and Westminster Hospital, London (UK) and four infectious disease departments (Sanremo, Galliera, San Martino, La Spezia) in Liguria, Italy (IT) known collectively as the Analisi Costi Terapia Antivirale network (ACTeA) have local populations of 470,000 and 700,000 respectively. All HIV medical admissions throughout 2012 were reviewed (surgical, paediatric, obstetrics and gynaecological admissions excluded); UK HIV cohort is 7400 and 3000 in IT. The principal clinical condition was prospectively collected from ACTeA onto an online platform by the lead clinician. In the UK electronic medical records and clinical coding were retrospectively reviewed by Italian and UK researchers, to reduce bias in the data collection. The International Classification of Diseases (ICD) 9 (IT)/10 (UK) were used in the centres involved and data was anonymised and stored securely. For standardisation, viral load 6 months Suppressed VL < 400 Poor adherence Failing regimen VL positive (copies/ml log10) Median IQR Route of infection Heterosexual sex Men having sex with men Drug use Other/unknown Hepatitis C co-infection Outcome/discharge location Usual residence Hospice/NHS Temporary placement Died Other/unknown Mortality rate (% total number) a b
IT n (%)
UK n (%)
All n (%)
257 205 147 (71.7)
474 316 269 (85.1)
731 521 416 (79.8)
49 45e53 16 14 222/257 (86.4)
46 38e52 89 389/474 (82.1)
47 41e53 11 12 611 (83.3)
175 (68.1) 302 157e434 222 (86.4) 162 (73) 169 (65.8) 49 (22) 4 (1.8)
324 (68.4) 368 147e575 389 (82.1) 253 (65) 319 (67.3) 25 (6.4) 10 (2.6)
499 (68.3) 330 147e508 611 (83.6) 415 (67.9) 488 (66.8) 74 (12.1) 14 (2.3)
4.36 4.04e5.10
4.63 3.42e5.43
4.06 3.61e5.30
47 (22.9) 25 (12.2) 132 (64.4) 1 (0.5) 126/205 (61.5)
60 (19.0) 188 (59.5) 20 (6.3) 48 (15.2) 47/316 (14.9)
107 (20.5) 213 (40.9) 152 (29.2) 49 (9.4)
177 (68.9) 0 (0.0) 23 (8.9) 21 (8.2)a 36 (14.0) 21 (10.2)
437 (92.2) 12 (2.5) 14 (3.0) 9 (1.9)a 2 (0.4) 9 (2.8)
614 (84.0) 12 (1.6) 37 (5.1) 30 (4.1) 38 (5.2) 30 (4.1)
p-valueb
www.elsevierhealth.com/journals/jinf
LETTER TO THE EDITOR Inpatient admissions of patients living with HIV in two European centres (UK and Italy); comparisons and contrasts
Dear Sirs, In this journal Sogard and colleagues described HIV comorbidities across in a very large pan-european population. However we think there may be striking differences between individual countries in Europe,1 so we are reporting our experience. Combined antiretroviral treatment (cART) has reduced morbidity and mortality rates2 in people living with HIV (PLWH) because of fewer opportunists infections, but premature age related co-morbidities3 and increased hospitalisation still occur.4 The future impact of non-infectious comorbidities (NICMs) on patient care and service provision is still unfolding and information on current admissions may be helpful in planning future services. This article gives a description of the clinical conditions and patient demographics of inpatient admissions in two HIV specialist centres. Chelsea and Westminster Hospital, London (UK) and four infectious disease departments (Sanremo, Galliera, San Martino, La Spezia) in Liguria, Italy (IT) known collectively as the Analisi Costi Terapia Antivirale network (ACTeA) have local populations of 470,000 and 700,000 respectively. All HIV medical admissions throughout 2012 were reviewed (surgical, paediatric, obstetrics and gynaecological admissions excluded); UK HIV cohort is 7400 and 3000 in IT. The principal clinical condition was prospectively collected from ACTeA onto an online platform by the lead clinician. In the UK electronic medical records and clinical coding were retrospectively reviewed by Italian and UK researchers, to reduce bias in the data collection. The International Classification of Diseases (ICD) 9 (IT)/10 (UK) were used in the centres involved and data was anonymised and stored securely. For standardisation, viral load 6 months Suppressed VL < 400 Poor adherence Failing regimen VL positive (copies/ml log10) Median IQR Route of infection Heterosexual sex Men having sex with men Drug use Other/unknown Hepatitis C co-infection Outcome/discharge location Usual residence Hospice/NHS Temporary placement Died Other/unknown Mortality rate (% total number) a b
IT n (%)
UK n (%)
All n (%)
257 205 147 (71.7)
474 316 269 (85.1)
731 521 416 (79.8)
49 45e53 16 14 222/257 (86.4)
46 38e52 89 389/474 (82.1)
47 41e53 11 12 611 (83.3)
175 (68.1) 302 157e434 222 (86.4) 162 (73) 169 (65.8) 49 (22) 4 (1.8)
324 (68.4) 368 147e575 389 (82.1) 253 (65) 319 (67.3) 25 (6.4) 10 (2.6)
499 (68.3) 330 147e508 611 (83.6) 415 (67.9) 488 (66.8) 74 (12.1) 14 (2.3)
4.36 4.04e5.10
4.63 3.42e5.43
4.06 3.61e5.30
47 (22.9) 25 (12.2) 132 (64.4) 1 (0.5) 126/205 (61.5)
60 (19.0) 188 (59.5) 20 (6.3) 48 (15.2) 47/316 (14.9)
107 (20.5) 213 (40.9) 152 (29.2) 49 (9.4)
177 (68.9) 0 (0.0) 23 (8.9) 21 (8.2)a 36 (14.0) 21 (10.2)
437 (92.2) 12 (2.5) 14 (3.0) 9 (1.9)a 2 (0.4) 9 (2.8)
614 (84.0) 12 (1.6) 37 (5.1) 30 (4.1) 38 (5.2) 30 (4.1)
p-valueb
