Late Presentation among Patients Diagnosed with HIV in an Inpatient Setting

Abstract

BackgroundDespite 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.MethodsCarolinas HealthCare System (CHS) is a nonprofit, 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.ResultsWe 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 with 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.ConclusionPatients 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.Disclosures All authors: No reported disclosures.