A retrospective analysis of HIV-positive patients admitted to the emergency department

Objective:This study aims to built a clinical anticipation for Emergency Room physicians in the patients with HIV regarding to their clinical profiles, common complaints during presentation, diagnoses, need and duration of hospitalization and discharge status, by examining the patients' demographic and clinical characteristics. The patient with HIV presented to the emergency department between January 2020 and December 2024 were included in the study.Materials and Methods:This retrospective cross-sectional study was conducted at the Emergency Department of Çukurova University Faculty of Medicine. All HIVpositive adult patients (age > 18 years) visited the emergency department between January 2020 and December 2024 were included in the study. Demographic and clinical data were analyzed using the statistical software package SPSS 27.0 (Released 2020). Results:During the 2020–2024 period, a total of 456 emergency visits of 252 HIV-positive adult patients (age > 18 years) were studied. Among these patients, 224 (88.9%) were male, and the mean age was calculated as 41.6 ± 12.9 years. Over the fiveyear period, 89.9% of the patients had visited the emergency department less than 5 times. When outpatient visits to the Infectious Diseases and Clinical Microbiology departments were analyzed, it was found that 162 patients (64.2%) admitted to the outpatient clinics more than 10 times. There was no statistically significant correlation between the frequencies of emergency admissions and the outpatient clinical visits (Spearman's = 0.050, p = 0.430). Among the patients, 115 (45.6%) had no chronic illness. The most common chronic condition was endocrinological disorders (n=25, 9.9%). At the time of admission, 71% of the patients (n=179) were receiving antiretroviral therapy (ART). Based on 3 level of triage, 50 patients (11%) were treated in the red zone (Critical Care Unit), 219 (48%) in the yellow zone (Observation Unit), and 187 (41%) in the green zone. The most common complaints during emergency admission were respiratory symptoms (18.9%), such as cough, shortness of breath, nasal discharge, sore throat, bloody sputum. The most frequent diagnoses made in the emergency department were infectious diseases (n=224, 49.1%) and respiratory tract infections (n=112, 24.6%). The length of stay in the emergency department ranges from 10 minutes to 119 hours, with an average duration of 398 ± 771 minutes. The majority of patients (72.4%) were discharged without the need for hospitalization. However, 98 patients (21.5%) required inpatient care, and 9 patients (6.4%) were admitted to the intensive care unit. 16 patients (3.5%) were accepted as exitus, but only 1 of these deaths were in the emergency department. When use of ART and hospitalization requirements were compared, it was observed that among 336 visits by patients on ART, 62 (18.5%) required hospitalization. In contrast, among 120 visits by patients not on ART, 36 (30%) required inpatient care. According to statistical analysis (χ² test, p=0.008), the need for hospitalization was significantly lower among patients using ART. The median length of stay in the emergency department was 360 minutes for patients who were later admitted to the intensive care unit (min: 3, max: 5760), and 186 minutes for those who were admitted to the hospital ward (min: 1, max: 7196). According to the Kruskal–Wallis test, there was no statistically significant difference between the groups (χ²=5.75, df=2, p=0.056). Conclusion:Regarding to the patients with HIV, emergency department admissions are mostly classified as moderately urgent. Non-compliance with treatment and the presence of comorbidities are are the risk factors associated with frequent emergency admissions. Consistent antiretroviral therapy significantly reduces both hospital admissions and intensive care requirements. These findings highlight the importance of maintaining continuum of HIV care and emphasize the role of emergency department as a critical point for early intervention and re-engagement in care of HIV patients. Key words: Emergency Department, Triage, HIV, AIDS, Antiretroviral Treatment