Introduction: The HIV epidemic has had a significant impact on the existing inpatient and outpatient health systems. The cost of inpatient care for HIV positive people has been shown to be greater than for HIV negative people and HIV infection has been associated with a higher inpatient mortality. These dynamics, in the face of an established antiretroviral program, have not been studied at district hospital level previously. Aim: The aim of this study was to describe the clinical patterns and cost implications in medical admissions at Helderberg Hospital, with particular reference to HIV infection and treatment. It includes a comparative analysis of HIV positive and HIV negative admissions. Methodology: This was a descriptive, quantitative study in the form of a cross-sectional survey. All medical admissions over defined 24 hour periods were recorded and data extracted from the medical records retrospectively. Results: 165 records were analysed. HIV prevalence was 19% and overall mortality 7%. 23(72%) of the 32 HIV positive patients had not yet accessed HIV services. The median CD4 count was 87cells/microl. The comparative analysis showed the HIV positive admissions to have a longer length of stay (5.9 days versus 3.6 days, p<0.01), higher laboratory costs (R717.28 versus R327.23, p<0.01) and higher pharmacy costs (R40.69 versus R11.72, p<0.01) than the HIV negative admissions. Outcomes for the HIV positive and negative patients were similar (p=0.64). Conclusion: Inpatient cost of care for HIV positive patients in this district hospital is more expensive than for HIV negative patients. Mortality rates in both groups are comparable. Antiretroviral therapy may be contributing to a decreased inpatient HIV prevalence and mortality rate. HIV positive patients are not accessing treatment in time to avoid morbidity requiring costly hospital admission. Further efforts are needed to expand outpatient HIV services, to explore the reasons why people with HIV are not accessing treatment timeously and to encourage rigorous treatment of HIV infected inpatients to ensure optimal outcomes.

Purpose: To compare the presenting symptoms and the outcomes of root canal therapy between HIV positive and HIV negative endodontic patients over a 6-12 month period. Methods: Fifty-nine HIV negative and 46 HIV positive patients presented for endodontic treatment. Signs and symptoms were noted and compared for both groups of patients, together with demographic data and CD4 counts for the HIV positive patients. Endodontic procedures were evaluated after an 18-month period. Endodontic treatment was assessed using clinical factors (palpation, percussion, sensitivity to hot and cold, swellings, excessive bleeding), and radiographic factors (periapical radiolucency, root resorption, periodontal ligament space). Results: There was no statistically significant difference in the preoperative presenting symptoms of endodontic infections/conditions between HIV positive and HIV negative patients. The prevalence of radiographic caries in the presenting teeth was only 24% in the HIV positive patients compared with 95% in the HIV negative patients. For the HIV positive patients, the treatment time required to resolution of the endodontic infection was nearly twice (113 minutes) that of the HIV negative patients (52 minutes). Amongst the HIV positive patients still experiencing symptoms at 18 months, pain was more severe in those patients with lower CD4 counts (significance at the 90% level of confidence). Conclusion: Within the limitations of this study the following conclusions emerge: 1. Although the success rate was lower over the period of this study in HIV positive patients, the rate is sufficiently high to warrant treatment. 2. Patients who are HIV positive may present with more severe symptoms and during treatment more bleeding may be expected. 3. In keeping with best practice for immuno-compromised patients, it would be advantageous to put HIV positive patients on antibiotic cover during treatment. 4. The process of anachoresis may explain the high incidence of endodontic infections in teeth with no history of trauma or caries in the HIV positive group.

Student Number : 9402058P - M Med Research Report - School of Clinical Medicine - Faculty of Health Sciences / Objective In view of recent suggestions that HIV infection may protect against pre-eclampsia, this study was done to estimate whether untreated HIV positive pregnant women have a lower rate of preeclampsia-eclampsia than HIV negative women. Methods Subjects for this study were pregnant women from Soweto, South Africa, who gave birth from March to December 2002 at midwife-run clinics or at the Chris Hani Baragwanath Hospital, and in whom the HIV status was known. A sample size calculation indicated that 2588 subjects would be required to show statistical significance at P<0.05 with a power of 80% for a reduction in the rate of preeclampsia from 8% to 5% with HIV seropositivity, assuming an HIV seroprevalence rate of 30%. Data collection was by record review from randomly selected patient files and birth registers. Results In the total sample of 2600 women, 1797 gave birth at the hospital and 803 at the midwife-run clinics. The HIV seroprevalence rate was 27.1%. Hypertension was found in 17.3% of women, with 5.3% having preeclampsia-eclampsia. The rates of preeclampsia-eclampsia were 5.2% in HIV negative and 5.7% in HIV positive women (P=0.61). CD4 count results were available for only 13 women (0.5%). Conclusion HIV seropositivity was not associated with any reduction in the risk of developing preeclampsia-eclampsia.