10 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 19, NO. 1, 2006 Rate of hospitalization and inpatient care costs for HIV-1-infected patients in Pune, India M. V. GHATE, S. P. TRIPATHY, B. KISHORE KUMAR, S. V. GODBOLE, A. CHITTAKE, P. NYAYANIRGUNE, R. R. GANGAKHEDKAR, A. D. DIVEKAR, M. R. THAKAR, A. R. RISBUD, R. C. BOLLINGER, S. M. MEHENDALE National AIDS Research Institute, Post Box 1895, G73, MIDC, Bhosari, Pune 411026, Maharashtra, India M. V. GHATE, S. P. TRIPATHY, B. KISHORE KUMAR, S. V. GODBOLE, A. CHITTAKE, P. NYAYANIRGUNE, R. R. GANGAKHEDKAR, A. D. DIVEKAR, M. R. THAKAR, A. R. RISBUD, S. M. MEHENDALE Johns Hopkins, University, Baltimore, Maryland, USA R. C. BOLLINGER Correspondence to M. V. GHATE; mghate@nariindia.org © The National Medical Journal of India 2006 ABSTRACT Background.The transition of human immunodeficiency virus (HIV) infection to acquired immune deficiency syndrome (AIDS) has begun in India, and an increase in AIDS-related hospitalizations and deaths is an anticipated challenge. We estimatedtheratesofhospitalizationandinpatientcarecostsfor HIV-1-infectedpatients. Methods. Data were analysed on 381 HIV-1-infected personsenrolledinaHIV-1discordantcouples’cohortbetween September 2002 and March 2004. Inpatient care costs were extracted from select hospitals where the study patients were hospitalizedandtheaveragecostperhospitalizationwascalcu- lated. Results .Amajorityofthepatientswereinanadvancedstate of HIV-1 disease with the median CD4 counts being 207 cells/ cmm (range: 4–1131 cells/cmm). In all, 63 participants who did not receive antiretroviral therapy required hospitalization, 53 due to HIV-1-related illnesses and the remaining 10 due to worseningofpre-existingconditions.TheoverallHIV-1-related hospitalization rate was 34.2 per 100 person-years (95% CI: 26.94–42.93). The median duration of HIV-1-related hospi- talization was 10 days (range 2–48 days) and the median cost was Rs 17 464 (range: Rs 400–63 891). Conclusion .It is necessary to strengthen the inpatient care infrastructureandsupportingdiagnosticset-up,andworkout economically optimized treatment algorithms for HIV-1-in- fectedpatients.Althoughthisanalysisdoesnotcoverallcostsand maynotbegeneralizable,thesebaselinedatamightbeauseful reference while planning related studies accompanying the government-sponsored programme to roll out antiretroviral therapy to AIDS patients. Natl Med J India 2006;19:10–14 INTRODUCTION The estimated number of human immunodeficiency virus (HIV) infections in India increased from a few thousand in the early 1990s to 5.13 million in 2004. 1 The main mode of HIV transmis- sion in India is heterosexual and a majority of HIV-infected individuals are between 15 and 44 years of age. 2 The standard medical care for HIV/acquired immune deficiency syndrome (AIDS) in India mainly consists of symptomatic treatment, chemo- prophylaxis and management of opportunistic infections. Though antiretroviral drugs are available in the Indian market, a majority of stakeholders cannot afford these on a sustained basis. Many Indian studies have described the commonly prevalent opportunistic infections among HIV-infected individuals, 3–5 but very little information is available on the rates of hospitalization and cost of management of this population. This could be due to lack of uniform recording of all HIV-related hospitalization events and different standards of care available across various geo- graphic regions. The face of the HIV epidemic is changing from HIV infection to AIDS in the high prevalence states and an increase in AIDS-related hospitalization events are expected. 1 Increased requirement of beds for AIDS patients in the coming years is likely to result in a substantial economic and administra- tive burden on hospitals. We aimed to determine the rates of hospitalization and esti- mate the costs of inpatient care in HIV/AIDS patients who were enrolled and followed in a cohort study of HIV serodiscordant couples in Pune, India. We also investigated the hospitalization events by CD4 T lymphocyte counts, presenting diagnoses and associated costs. METHODS Background A prospective cohort study of 400 HIV-1 serodiscordant couples is being carried out at Pune, India to generate information on the incidence of HIV-1 infection in uninfected partners and identifi- cation of associated risk factors among HIV-1 serodiscordant couples. This study enrolled 381 HIV-1 infected participants and their spouses between September 2002 and March 2004. The present analysis is restricted to 53 HIV-infected persons in this cohort who were antiretroviral therapy (ART) naïve and required hospitalization for HIV-related conditions. The cost analysis does not include the cost of antiretroviral drugs. We identified HIV-1 serodiscordant couples at our study clinics. The couples under- went eligibility screening for participation in the cohort study after providing written, informed consent. Eligible discordant couples were enrolled in the study and were evaluated clinically at 3-monthly intervals for a period of 1 year. The study procedures at each visit included pre- and post-HIV test counselling, couples’ counselling, clinical examination, CD4 T lymphocyte counts and