Degree of Disease Progression in Homeless HIV/AIDS Patients during the First Medical Visit / 감염과화학요법

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/microL, interquartile range: 44-383/microL) were significantly lower than those of the National Health Insurance beneficiaries (median: 267/microL, interquartile range: 159-397/microL; P=0.024). In addition, the proportion of patients whose CD4 cell counts <200/microL 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). 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.

A report of seven cases of progressive multifocal leukoencephalopathy in patients with acquired immune deficiency syndrome / 대한내과학회지

Secondary opportunistic central nervous system infections occur in approximately one-third of patients with acquired immune deficiency syndrome. With the introduction of highly active antiretroviral therapy, the number of opportunistic infection cases has significantly decreased. However, the number of progressive multifocal leukoencephalopathy (PML) cases caused by opportunistic human JC polyomavirus has not decreased at a noticeable rate. In this report, seven patients with PML were evaluated at the infectious disease unit of the National Medical Center. Six of the 7 patients were not on antiretroviral therapy at the time of diagnosis. The mean patient age of the 6 men and 1 woman was 39 years. The individual CD4 cell counts were 58, 6, 18, 73, 90, 252, and 94 cells/microliter. The mean CD4 cell count was 84 cells/microliter. The most common clinical manifestation was focal weakness and the temporal lobe was mainly involved. Two of the patients died 52 days after the diagnosis was made. Three patients survived for more than 1 year without disease progression. We conclude that one must take a careful patient history, perform a neurological examination, and examine brain magnetic resonance images in patients with human immunodeficiency virus who show neurological symptoms.