Impact of immunosuppression on health care use by men in the multicenter AIDS cohort study (MACS)

Sharon L. Zucconi, Lisa P. Jacobson, Lewis K. Schrager, Nancy E. Kass, Judith R. Lave, Catherine A. Carson, Hal Morgenstern, Peter S. Arno, Neil M.H. Graham

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19 Scopus citations


The effects of human immunodeficiency virus type 1 (HIV-1) se- rostatus, AIDS, and level of immunosuppression on health service use were examined in the Multicenter AIDS Cohort Study. Data on self-reported hospitalizations, outpatient medical services (non-emergency room) and emergency room care during the preceding 6 months were collected for 3,447 homosexual/bisexual men returning for their 14th and/or 15th semiannual visits in Chicago, Baltimore, Los Angeles, and Pittsburgh. AIDS-free seropositive men with CD4+ cells <200/p.l were more likely to be hospitalized [odds ratio (OR) = 2.3, 95% confidence limits (CL) = 1.4, 3.8] and use outpatient medical care (OR = 7.9, 95% CL = 4.9, 12.6), compared with seronegative men. Increased outpatient care was initiated at the earliest stages of HIV-1 infection, even when CD4+ cells were >500/μl. Dramatic increases in outpatient care for each level of immunosuppression were observed. HIV-1-related symptoms were associated with increased hospitalizations (OR = 4.8, 95% CL = 3.2, 7.3), use of outpatient medical services (OR = 3.3, 95% CL = 1.9, 5.6), and emergency room care (OR = 3.1, 95% CL = 2.1, 4.6). Persons with AIDS and ≤50 CD4+ cells/μl were most likely to be hospitalized (OR = 8.1; 95% CL = 4.4, 14.9). No significant difference (p > 0.05) in emergency room use was observed according to HIV-1 serostatus, AIDS, or immunosuppression, after adjusting for insurance and clinical symptoms. To the extent that CD4+ cell counts are used as one of the criteria for an AIDS diagnosis and such a diagnosis broadens available benefits to persons with HIV disease, the pattern of health care services described here will be important for health care providers and planners.

Original languageEnglish (US)
Pages (from-to)607-616
Number of pages10
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number6
StatePublished - Jun 1994
Externally publishedYes


  • Cost
  • HIV
  • Health care use
  • Immunosuppression


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