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A Profile of Hospitalized HIV-Positive Patients in Two U.S. Cities

Most HIV-positive patients hospitalized at two urban medical centers reported a lack of previous outpatient HIV care and no current use of antiretrovirals.

Up to one third of HIV-positive patients obtain much of their care in acute care hospitals, according to some studies. To learn more about factors associated with high-risk sexual behavior and use of HIV services in urban settings, researchers interviewed 1038 HIV-positive patients who had been hospitalized at academic medical centers in Miami and Atlanta. Interviews were conducted during 2006 and 2007 as part of the screening process for Project HOPE, a randomized controlled trial of a brief intervention for HIV-positive crack cocaine users. Of the cohort, 60% were men, 71% were aged >40, 82% were black, and 56% reported an annual income <US$5000; 34% reported crack cocaine use, and 32% reported heavy alcohol use.

Although 68% of participants had known their HIV-positive status for at least 5 years, 20% of the entire cohort had never seen an HIV-care provider (40% hadn’t seen one during the previous 6 months), and only 42% were on antiretroviral therapy (ART) at the time of the interview. Ten percent of participants reported having unprotected sex during the previous 6 months with a partner whose HIV status was negative or unknown. Both crack cocaine use and heavy alcohol use were significantly and independently associated with lack of previous contact with an HIV-care provider, lack of current ART use, and recent high-risk sexual behavior.

Comment: This study provides a sobering look at the reality of HIV care for a select group of city dwellers who struggle with substance abuse and poverty. Despite being aware of their seropositive status, many of these patients do not receive ongoing outpatient care, and they continue to engage in high-risk behaviors. The next step is to determine whether aggressive hospital-based interventions might help to bring some of these patients into care. Increasing attention to hospitalized patients with HIV has the potential not only to improve their health status but also to prevent transmission of HIV to uninfected people.

— Sonia Nagy Chimienti, MD

Published in Journal Watch HIV/AIDS Clinical Care June 8, 2009

Citation(s):

Metsch LR et al. Hospitalized HIV-infected patients in the era of highly active antiretroviral therapy. Am J Public Health 2009 Jun; 99:1045.

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