Clinical Characteristics And Hospitalization Of HIV/AIDS Patients With Mental Disorders

ObjectiveTo understand the clinical characteristics,treatment and hospitalization expenses and length of stay of HIV/AIDS patients with mental disorders,so as to increase the understanding of the HIV/AIDS patients with mental disorders and provide help for clinical diagnosis and treatment,To provide help for clinical diagnosis and treatment,and to provide reference for the development of intervention and management measures for HIV/AIDS patients with mental disorders.MethodsAll HIV/AIDS patients with mental disorders admitted to Yunnan infectious disease hospital/mental health centerd from 2017 to 2020 were collected as the research objects.The demographic data,epidemiological data,clinical data,imaging data and the inpatient medical records of the subjects were taken as the research contents.Retrospectively analyzed the epidemiological characteristics of HIV/AIDS patients with mental disorders.According to different types of mental disorders,the clinical characteristics and hospitalization were compared,and the influencing factors of HIV/AIDS complicated with organic mental disorders were analyzed.Results1.Types of mental disorders and demographic characteristics:From2017 to 2020,7.0%of the HIV/AIDS patients in our hospital were complicated with mental disorders,and there had an increasing trend year by year,among which the proportion of complicated with organic mental disorders had a decreasing trend.The research objects are mainly aged 30-49years old male.There was no significant difference in age between male and female（t=0.323,P=0.747）;81.7%of them were farmers and unemployed;The majority of them were Han nationality（74.8%）,52.4%of them were married,most of them were born in Kunming City（31.3%）,and most of them were sexually transmitted（86.5%）.2.Clinical features:The mainly HIV related clinical features were cough and expectoration（36.5%）,fatigue（33.5%）,dizziness and headache（26.8%）,fever（26.8%）,enlarged breath sounds in both lungs（56.2%）,and white covering of oral mucosa（31.3%）.HIV/AIDS with organic mental disorders Patients had more cough and expectoration（χ²=5.034,P=0.025）,dizziness and headache（χ²=6.551,P=0.010）,fever（χ²=9.951,P=0.002）,enlarged respiratory sounds in both lungs（χ²=4.823,P=0.028）and so on,than non organic mental patients;The mainly mental symptoms of HIV/AIDS with organic mental disorders Patients were 53.3%of social function impairment,39.6%of emotional disorder,38.6%of behavioral disorder,102%of Thinking form obstacle,25.2%of anxiety,21.0%of delusion,19.8%of hallucination.3.Other complications:The mainly infectious diseases of subjects were bacterial pneumonia（21.7%）,tuberculosis（20.1%）and tuberculous meningitis in（7.3%）;the mainly non opportunistic infections disease were electrolyte disorder（14.1%）,hyperlipidemia（12.8%）and HCV（10.9%）.There were more Pulmonary tuberculosis（χ²=10.176,P=0.001）,PCP（χ²=10.561,P=0.001）,CMV（χ²=8.988,P=0.003）,cryptococcal meningitis（χ²=6.839,P=0.009）,PML（χ²=20.446,P=0.000）,tuberculous meningitis（χ²=45.935,P=0.000）in HIV/AIDS with organic mental disorders Patients compare with HIV/AIDS with non-organic mental disorders Patients.4.Organic mental disorder:Among the 76 HIV/AIDS patients with organic mental disorders,31 patients showed cognitive impairment,and 45 patients showed non-cognitive impairment.The underlying diseases related to Organic mental disorder were HIV encephalopathy,tuberculous meningitis and other physical diseases caused by HIV infection.The mainly mental symptoms of patients with cognitive impairment were:memory decline,calculation ability decline,retarded reaction,and physical activity disorder.The mainly mental symptoms of patients with non-cognitive impairment were:behavior disorder,thinking form disorder,emotional disorder,and delusion.The independent risk factors of organic mental disorder were poor adherence（OR=5.400,95%CI:1.985-14.690,P=0.001）,no HAART（OR=3.435,95%CI:1.472-8.013,P=0.004）,intracranial infection（OR=4.532,95%CI:1.990-10.320,P=0.000）,cerebral infarction（OR=5.400,95%CI:1.985-14.690,P=0.001）,divorce（OR=2.616,95%CI:1.219-5.614,P=0.014）.CD₄⁺T（OR=0.997,95%CI:0.995-0.999,P=0.002）was a protective factor for HIV/AIDS complicated with organic mental disorders.5.Readmission and Length of stay:During 2017-2020,the average hospitalization times of HIV/AIDS patients with mental disorders,HIV/AIDS patients and mental disorders were 2.3,1.34 and 3.5 times respectively,and the readmission patients accounted for 55.8%,21%and 39.5%respectively.The median single length of stay was 32（19,59）,21（12,38）and 62（45,68）days respectively,and the individual cumulative length of stay was 55（24,103）,36（20,60）and 48（21,161）days respectively.6.Hospitalization expenses:During 2017-2020,the single hospitalization expenses 11552（662516826）and individual cumulativ ehospitalization expenses20660（8714,43770）yuan of HIV/AIDS with mental disorders patients were higher than HIV/AIDS patients 9216（4838,17471）,11771（5798,23840）yuan,and mental disorder patients 10203（6502,12945）,10180（6364,31032）yuan,respectively.The cumulative hospitalization expenses of patients with mood disorders and schizophrenia were the highest,and the western medicine expenses were the largest expenses among all types of mental disorders.conclusion1.From 2017 to 2020,7.0%of the HIV/AIDS patients in our hospital were complicated with mental disorders,and there was an increasing trend year by year.Whereas,the HIV/AIDS patients complicated with organic mental disorders had a decreasing trend year by year.Most of them are young and middle-aged married male of Han nationality.The mainly route of HIV infection is sexual transmission,and the drug abuse rate is high.2.The clinical features of HIV/AIDS patients with mental disorders are diverse and atypical,and respiratory and nervous system symptoms are common.We should pay attention to the care and management of these patients,in addition to actively preventing their opportunistic infections,we should also pay attention to their non opportunistic infections.3.There are many influencing factors of HIV/AIDS complicated with organic mental disorder.We should actively carry out HAART treatment,ensure the compliance of HAART treatment and prevent intracranial infection.5.The HIV/AIDS with mental disorder patients had more readmission patients,and higher hospitalization costs and longer hospitalization time,there is a heavy disease burden.