Although more American adults than children are
infected with the HIV virus, children with the disease use
more HIV-related health care services, a
Johns Hopkins
Children's Center researcher reports.
"Because infants and toddlers are more likely to visit
their pediatrician on a regular basis, and because
physicians believe that administering highly active
antiretroviral therapy to babies and infants early on helps
establish and maintain levels of viral suppression, we
weren't really surprised by these results," said the
study's lead author, George Siberry, a pediatrician at the
Children's Center.
"However, our study — believed to be one of the
first to examine health care utilization patterns of
HIV-infected children since the widespread use of HAART
— also suggest that the demand for care for
HIV-positive children means we need to look carefully at
how we are delivering it and what more we can do to improve
access and services," he added.
In their report, presented Nov. 3 at the American
Academy of Pediatrics 2003 National Conference and
Exhibition in New Orleans, investigators at Johns Hopkins
and five other institutions from the HIV Research Network
report that HIV-positive children — particularly
those under 2 years of age — make a high number of
outpatient visits and are frequently hospitalized.
Furthermore, 90 percent of all HIV-infected children
receive antiretroviral medications.
According to the U.S. Centers for Disease Control and
Prevention, by the year 2001 there were more than 170,000
adults and adolescents and approximately 4,000 children in
the United States infected with the HIV virus (these
statistics may not include data from all 50 states).
"An understanding of how real HIV patients access the
health care system, and what services they do or do not
utilize, provides policy-makers, medical providers and HIV
program managers with the knowledge to make important
decisions on HIV care that reflects what is really
happening out there in the HIV community," Siberry said.
In the current study, Siberry and colleagues examined
the clinical records of 364 HIV-infected children seen in
2000 at five pediatric sites of the HIV Research Network.
The children, mostly female and African-American, were all
infected by transmission of the virus from their infected
mother during pregnancy or delivery.
In particular, researchers focused on the number of
inpatient and outpatient visits, in addition to how many
children were prescribed ART. They found that HIV-infected
children had an average of eight yearly outpatient visits
and a one-in-three chance of requiring inpatient admission
in the year 2000. HIV-infected children under 2 years of
age had more than nine outpatient visits per year and a
two-in-three chance of being admitted during that year.
Compared to healthy children in the United States,
HIV-infected children are hospitalized 10 times more often
and have three times as many yearly outpatient visits.
Although hospitalization rates for children with HIV were
slightly lower than that of HIV-infected adults, the
children had 30 percent more outpatient visits.
In addition to younger children, children with more
advanced HIV infection, high viral loads or AIDS, or those
of non-Caucasian ethnicity, had significantly more
outpatient visits and hospitalizations in 2000.
"The good news from these findings is that
hospitalization rates and outpatient visits for
HIV-infected children appear to be three to four times
lower than they were for HIV-infected children in the early
1990s when HAART therapy was not available," Siberry said.
The HIV Research Network comprises 18 medical
institutions located across the United States that treat
more than 16,000 patients with HIV disease. Each
institution assembles data on the clinical and demographic
characteristics of its HIV-infected patients, the frequency
of each patient's outpatient clinic visits and the number
of inpatient admissions. Participating institutions then
send the information to the data coordinating center
located at the Johns Hopkins School of Medicine, where the
information is consolidated into a single uniform
database.
Co-authors of this study are Kelly Gebo of the Johns
Hopkins School of Medicine; Richard Rutstein of Children's
Hospital of Philadelphia; Patricia Flynn of St. Jude's
Children's Hospital; and Stephen Spector of the University
of California, San Diego.
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