Abstract
Background
In the Korean healthcare system, medical care for HIV patients was provided by a few university affiliated hospitals. Access to these tertiary hospitals by homeless people living with HIV was difficult due to socioeconomic reasons. Consequently, proper treatment for homeless subjects living with HIV was not delivered in a timely manner. This study compares the degree of disease progression of HIV infection/AIDS between homeless and non-homeless patient groups.
Materials and Methods
Out of 605 HIV/AIDS patients who visited the Center for Infectious Disease, National Medical Center, Seoul, Korea from August 2003 to May 2010, 295 subjects were included for this study. Referred cases (n=310) were excluded. The study subjects were further classified into three socioeconomic groups: National Health Insurance beneficiaries, Medical Aids beneficiaries, and the homeless. Status of HIV/AIDS disease progress was evaluated by peripheral blood CD4 cell count and the presence of AIDS defining illnesses at the first visit.
Results
There were 220 National Health Insurance beneficiaries (male 94.1%), 45 Medical Aids beneficiaries (male 88.9%), and 30 homeless people (male 96.7%). CD4 cell counts of the homeless (median: 119/µL, interquartile range: 44-383/µL) were significantly lower than those of the National Health Insurance beneficiaries (median: 267/µL, interquartile range: 159-397/µL; P=0.024). In addition, the proportion of patients whose CD4 cell counts <200/µL was significantly higher in homeless subjects (53.3%) compared to those in the National Health Insurance beneficiaries (27.3%) and the Medical Aids beneficiaries (28.9%) (P=0.004; P=0.033 respectively). Also, the frequency of AIDS defining illnesses was higher in the homeless (73.3%) than for those in other groups (the Health Insurance beneficiaries: 24.5%; the Medical Aids beneficiaries: 40.0%) (P<0.001; P<0.005 respectively).
Figures and Tables
References
1. Disease Information: acquired immunodeficienty syndrome. Korea Centers for Disease Control and Prevention (KCDC). Accessed 24 November 2010. Available at: http://www.cdc.go.kr/kcdchome/jsp/diseasedic/dic/DISEDIC0001 Detail.jsp?menuid=510677&contentid=7667&boardid=null&appid= kcdcdz01&pageNum=null&sub=null&tabinx=1&q_had01=A&q_ had02=2010&idxType=1&idxNum=14.
2. Goh UY. Epidemiologic characteristics, estimation and prediction of HIV/AIDS epidemic in Korea. 2001. Seoul: Hanyang University;[Ph.D. thesis].
3. Shin HY. Estimation of HIV/AIDS cases in 2002 (Abstract MS1-1). Abstract presented at: 55th annual conference of the Korean Society for Preventive Medicine. 2003 October 23-25; Pyoungchang, Korea:
4. Yang BM, Choi WJ. The economical impacts of HIV/AIDS infection in Korea. Accessed 24 November 2010. Available at: http://www.aidsinfo.or.kr/Board/Down_Files/7th_Symposium_02.pdf.
5. Beom SH, Lee SH, Lee JM, Hong SH, Kim YJ, Lee HJ, Choi JP, Koo MS. A study on the prevalence of HIV-positive homeless patients in a public hospital. Korean J Med. 2007. 73:Suppl 3. S162.
6. Centers for Disease Control and Prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992. 41:1–19.
7. Gazzard BG, Anderson J, Babiker A, Boffito M, Brook G, Brough G, Churchill D, Cromarty B, Das S, Fisher M, Freedman A, Geretti AM, Johnson M, Khoo S, Leen C, Nair D, Peters B, Phillips A, Pillay D, Pozniak A, Walsh J, Wilkins E, Williams I, Williams M, Youle M. BHIVA Treatment Guidelines Writing Group. British HIV Association Guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008. HIV Med. 2008. 9:563–608.
8. Guidelines: Clinical management and treatment of HIV infected adult in Europe, version5-2. European AIDS Clinical Society. Accessed 24 November 2010. Available at http://www.europeanaidsclinicalsociety.org/Guidelines/index.htm.
9. Guidelines for the use of antiretroviral agents in HIV-1-Infected adults and adolescents, Dec 1, 2009. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Accessed 24 November, 2010. Available at http://www.aidsinfo.nih.gov/Guidelines/GuidelineDetail.aspx?MenuItem=Guidelines&Search=Off&GuidelineID=7&ClassID=1.
10. Thompson MA, Aberg JA, Cahn P, Montaner JS, Rizzardini G, Telenti A, Gatell JM, Gunthard HF, Hammer SM, Hirsch MS, Jacobsen DM, Reiss P, Richman DD, Volberding PA, Yeni P, Schooley RT. International AIDS Society-USA. Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel. JAMA. 2010. 304:321–333.
11. Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, Hogg RS, Deeks SG, Eron JJ, Brooks JT, Rourke SB, Gill MJ, Bosch RJ, Martin JN, Klein MB, Jacobson LP, Rodriguez B, Sterling TR, Kirk GD, Napravnik S, Rachlis AR, Calzavara LM, Horberg MA, Silverberg MJ, Gebo KA, Goedert JJ, Benson CA, Collier AC, Van Rompaey SE, Crane HM, McKaig RG, Lau B, Freeman AM, Moore RD. NA-ACCORD Investigators. Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med. 2009. 360:1815–1826.
12. Kim HR. The relationship of socioeconomic position and health behaviors with morbidity in Seoul, Korea. Health Soc Welf Rev. 2005. 25:3–35.
13. Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991. 337:1387–1393.
14. Introduction of Division of HIV and Tb Control. Korea Centers for Disease Control and Prevention. Accessed 24 November 2010. Available at: http://www.cdc.go.kr/kcdchome/jsp/home/introduction/omo/INTROMO0800List.jsp?menuid=102039&q_firstorgid=1351168&q_secondorgid=1351169.
15. Introduction of partners and business. Korea AIDS Information Center. Accessed 24 November 2010. Available at: http://www.aidsinfo.or.kr/Board/Html/Infor_06_01_01.html#.
16. Thompson PI, Jones TS. Monitoring and documenting community-based organization outreach activities for populations at risk for HIV. Hygie. 1990. 9:34–38.
17. Woods ER, Samples CL, Melchiono MW, Keenan PM, Fox DJ, Chase LH, Tierney S, Price VA, Paradise JE, O'Brien RF, Mansfield CJ, Brooke RA, Allen D, Goodman E. Boston HAPPENS Program: a model of health care for HIV-positive, homeless, and at-risk youth. Human immunodeficiency virus (HIV) Adolescent Provider and Peer Education Network for Services. J Adolesc Health. 1998. 23:2 Suppl. 37–48.
18. Wawer MJ, Gray RH, Sewankambo NK, Serwadda D, Li X, Laeyendecker O, Kiwanuka N, Kigozi G, Kiddugavu M, Lutalo T, Nalugoda F, Wabwire-Mangen F, Meehan MP, Quinn TC. Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. J Infect Dis. 2005. 191:1403–1409.
19. Montaner JS, Lima VD, Barrios R, Yip B, Wood E, Kerr T, Shannon K, Harrigan PR, Hogg RS, Daly P, Kendall P. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet. 2010. 376:532–539.
20. Wilson DP, Law MG, Grulich AE, Cooper DA, Kaldor JM. Relation between HIV viral load and infectiousness: a model-based analysis. Lancet. 2008. 372:314–320.