Significant
decreases were seen in hospitalizations for opportunistic and nonopportunistic infections. The first substantial clinical benefit from HAART may be realized by 90 days after HAART initiation; providers should keep close vigilance at least until this time. In the short term after starting highly active antiretroviral therapy (HAART), HIV-infected patients may have an increased risk of serious illness as a result of an immune reconstitution inflammatory syndrome (IRIS), a traditional opportunistic infection (OI), or an adverse drug reaction. While HAART is known to decrease hospitalization rates and mortality in the long term [1–7], the time at which hospitalization risk declines during the weeks Selleck Etoposide to months immediately following HAART initiation is not clear. In studies in high-income Raf inhibitor countries conducted since the advent of HAART in 1996, AIDS-defining illnesses (ADIs) and non-ADI infections have been the most frequent reasons for hospital admission [1,4,6,8–11]. The next most common categories of admitting diagnoses have varied among mental illness, gastrointestinal and hepatic disease, and cardiovascular disease. Studies have compared hospitalization rates for these disease categories in the several years prior to the
advent of HAART vs. the several years after its advent among cohorts of patients, not all of whom were prescribed HAART [1,4,5,12–17]. These studies did not determine changes in an individual’s risk of serious illness within these disease categories in the weeks to months immediately after initiating HAART. Our main objective was to measure the rates
of all-cause hospitalizations over time in the year after HAART initiation using an urban clinical cohort of HAART-naïve, HIV-infected patients. To assess the effect on hospitalization rates produced by having a significant virological response Cepharanthine to HAART, we compared hospitalization rates in virological responders and nonresponders. We examined causes of hospitalization by diagnostic category. All patients who engage in HIV continuity care with the Johns Hopkins AIDS service are offered enrolment in the observational Johns Hopkins HIV Clinical Cohort (JHHCC). Fewer than 1% of patients have refused [18]. As part of this study, trained abstractors extract demographic, pharmaceutical and hospitalization data from patient charts at 6-month intervals. Laboratory data are retrieved directly from the hospital laboratory system. The JHHCC is approved by the Institutional Review Board of the Johns Hopkins School of Medicine. All HAART-naïve patients initiating HAART (previous antiretroviral use was allowed) between 1 January 1997 and 31 December 2006 were considered for inclusion in this analysis. HAART was defined as any combination of at least three drugs which included at least two classes selected from the nucleoside reverse transcriptase inhibitor (NRTI), nonnucleoside reverse transcriptase inhibitor (NNRTI) and protease inhibitor (PI) classes.