처음 의료기관을 내원하는 노숙 Human immunodeficiency virus 감염인의 질병 진행 정도
Degree of Disease Progression in Homeless HIV/AIDS Patients during the First Medical Visit
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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%), 45Medical 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=0.033respectively). 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). Conclusions: Homeless people living with HIV tend to seek medical care in far advanced stage, which may attribute to poor prognoses. More organized and strategic interventions are necessary to find and treat homeless people living with HIV at the early stage.
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%), 45Medical 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=0.033respectively). 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). Conclusions: Homeless people living with HIV tend to seek medical care in far advanced stage, which may attribute to poor prognoses. More organized and strategic interventions are necessary to find and treat homeless people living with HIV at the early stage.
참고문헌 (22)
- "Disease Information: acquired immunodeficienty syndrome"[URL]
- Goh UY, "Epidemiologic characteristics, estimation and prediction of HIV", AIDS epidemic in Korea, Hanyang University, 2001
- Shin HY, "Estimation of HIV", AIDS cases in 2002 (Abstract MS1-1), 2003, ~
- "The economical impacts of HIV/AIDS infection in Korea"[URL]
- Beom SH, "A study on the prevalence of HIV-positive homeless patients in a public hospital", Korean J Med, 73(3), pp.S162~ (2007)
- 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, 41, pp.1~19 (1992)
- Gazzard BG, "British HIV Association Guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008", HIV Med, 9, pp.563~608 (2008)
- "Guidelines: Clinical management and treatment of HIV infected adult in Europe, version5-2"[URL]
- "Guidelines for the use of antiretroviral agents in HIV-1- Infected adults and adolescents, Dec 1, 2009"[URL]
- Thompson MA, "International AIDS Society-USA. Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel", JAMA, 304, pp.321~333 (2010)
- Kitahata MM, "Effect of early versus deferred antiretroviral therapy for HIV on survival", N Engl J Med, 360, pp.1815~1826 (2009)
- Kim HR, "The relationship of socioeconomic position and health behaviors with morbidity in Seoul, Korea", Health Soc Welf Rev, 25, pp.3~35 (2005)
- Marmot MG, "Health inequalities among British civil servants: the Whitehall II study", Lancet, 337, pp.1387~1393 (1991)
- "Introduction of Division of HIV and Tb Control"[URL]
- "Introduction of partners and business"[URL]
- Thompson PI, "Monitoring and documenting communitybased organization outreach activities for populations at risk for HIV", Hygie, 9, pp.34~38 (1990)
- Woods ER, "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, 23(2 Suppl), pp.37~48 (1998)
- Wawer MJ, "Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda", J Infect Dis, 191, pp.1403~1409 (2005)
- Montaner JS, "Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population- based study", Lancet, 376, pp.532~539 (2010)
- Wilson DP, "Relation between HIV viral load and infectiousness: a model-based analysis", Lancet, 372, pp.314~320 (2008)
- Garnett GP, "Risk of HIV transmission in discordant couples", Lancet, 372, pp.270~271 (2008)
- Townsend CL, "Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006", AIDS, 22, pp.973~981 (2008)