VA RESEARCH ON AVOIDING HIV COMPLICATIONS -- The findings
of the study support a recommendation to screen
all patients
in all healthcare settings for HIV-infection.
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Avoiding HIV complications
Despite the availability of life-saving antiretroviral treatment, people
infected with HIV (human immunodeficiency virus) continue to die and
suffer from complications of AIDS, mainly due to delayed diagnosis and
initiation of treatment. A researcher at the Albert Einstein College of
Medicine of Yeshiva University and colleagues at Yale University have shed
light on why this problem persists. They report their findings in the
November issue of the journal Medical Care.
Led by Dr. Neel Gandhi, assistant professor of medicine and of
epidemiology and population health at Einstein, the researchers examined
4,368 patients presenting for AIDS treatment to Veteran’s Administration
(VA) Medical Centers nationwide for the first time between 1998 and 2002.
Their aim was to determine whether patients who had received medical care
in the VA healthcare system were diagnosed with the HIV infection that
causes AIDS earlier than patients outside the VA or those who were
accessing the VA system for the first time.
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Half of all the patients in the study had AIDS at
the time of presentation—a high rate that nevertheless was similar to
studies conducted outside the VA healthcare system. “What was particularly
astounding to us was the fact that 40 percent of these patients with AIDS
had previously received medical care at the VA for other illnesses, but
had not been diagnosed with HIV infections and treated earlier,” explains
Dr. Gandhi. “This occurred even though they had an average of six
physician visits over three-and-a-half years. Even more concerning was
that those patients who already interacted with the healthcare system for
several years suffered the end-stage complications of AIDS at the same
rate as those who were new to the VA healthcare system.”
One explanation for why this may occur is that patients with HIV infection
remain asymptomatic until very late in the disease, providing few clues to
doctors of the patient’s underlying HIV infection. “In our study, we found
that only 12% of patients with AIDS at the time of presentation for
treatment had previously suffered from an illness indicative of
unrecognized HIV infection,” notes Dr Gandhi. “The vast majority of these
patients with AIDS had no signs or symptoms of HIV infection until they
suffered end stage complications from AIDS. Most of these AIDS
complications could have been prevented if these HIV-infected people had
been routinely screened when they were first seen by a doctor and had
begun antiretroviral treatment earlier.”
He adds, “A previously published study has shown routine screening for HIV
infection is a cost-effective addition to the screening done for other
life-threatening diseases, such as heart disease and several types of
cancer. Assuming that patients give their permission to be screened for
HIV, the potential savings from diagnosing an infection earlier would be
quite significant.”
The findings of the study support a recommendation by the US Centers for
Disease Control and Prevention (CDC) to screen all patients in all
healthcare settings for HIV-infection.
Dr. Gandhi conducted much of this study as a member of the Robert Wood
Johnson Clinical Scholars Program of Yale University, with colleagues from
Veterans Aging Cohort Study of the West Haven Veteran’s Administration
Hospital. The research received funding from the Robert Wood Johnson
Clinical Scholars Program, The National Institute of Alcoholism and
Alcohol, and the Veterans Affairs Office of Research and Development. Dr.
Gandhi joined the faculty of the Albert Einstein College of Medicine in
August 2006.
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