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

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/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.