Influence of vaccine-preventable diseases and HIV infection on demand for an infectious diseases service in Rio de Janeiro State, Brazil, over 22 years - Part II (1995-2016).

Patients' data during daily clinical care are extremely important for improving the allocation of healthcare resources and for assessing healthcare demands. The prospective gathering of these data over decades allowed us to describe the trends of infectious diseases in a tertiary hospital. The results concerning the period between 1965 and 1994 described the exponential increase in the incidence of HIV infection and its important effects on our institutional mortality. The present study describes the demand for the same hospital between 1995 and 2016. There were 4,691 admissions and the main causes of admissions were, in descending order, HIV infection (1,312, 28.0%), noninfectious diseases (447, 9.5%), meningoencephalitis (432, 9.2%), soft tissue infections (427; 9.1%), tuberculosis (272, 5.8%), pneumonias (212, 4.5%) and leptospirosis (212, 4.5%). There were 864 readmissions; most due to HIV infections (65.2%). The institutional mortality fell from 16.9% in the first two years to 5.0% in the last two years of the study. The case-fatality rates among the HIV patients decreased from more than 40% to approximately 5% over the study period. In the last two decades, the hospital experienced a decrease in demand due to vaccine-preventable diseases. The demand for children has fallen and the demand for patients over the age of 50 has increased. These results reflect the improvement in public health standards over more than half a century and the positive effects of the National Immunization Program. They also illustrate the sharp decline in the HIV case-fatality rate after the introduction of combined antiretroviral therapy.