Alcohol Abuse Prevalence in HIV Patients Contributes to Complex Care Needs

HIV patients who have complex comorbidities are among the most vulnerable and challenging patients for physicians and members of a multidisciplinary team, and more information is needed to identify interventions that can help manage these patients effectively.

That’s why researchers in Toronto set out to determine how patient demographics have changed at a facility that once primarily served hospice needs, but now provides primarily supportive care and linkages to services. The changing demographic reflects treatment advances in the last 20 years, as patients are living longer, requiring less end-of-life care, and needing more chronic supportive care.

The 83 HIV patients admitted to Casey House in 2008 all had high care needs. Unable to independently manage themselves, they needed a community-based flexible alternative to acute care hospitalization. A full 50 percent of those patients admitted to actively using alcohol at admission, although the study authors suspected that figure had underestimated actual use.

Among the Casey House population, 19 percent died, which the researchers said reflects early mortality. Without existing complexities in their conditions, those patients may have been expected to live considerably longer. Patients at Casey House were psychologically challenged, had multiple medical comorbidities, and took an average of 11 medications. Additionally, almost half of them were cognitively impaired.

The researchers concluded that their findings underscore the need for improved medical and psychiatric care coordination. In addition, this vulnerable population will not benefit from advances in HIV/AIDS treatment unless physicians integrate harm reduction services and psychosocial and recovery-oriented interventions.