Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005-2015

• Type of Material: Article
• Authors: John Brooks, Emory University; Thibaut Davy-Mendez, University of North Carolina; Sonia Napravnik, University of North Carolina; Brenna C Hogan, Johns Hopkins University; Keri N Althoff, Johns Hopkins University; Kelly A Gebo, Johns Hopkins University; Richard D Moore, Johns Hopkins University; Michael A Horberg, Kaiser Permanente Midatlant Permanente Res Inst; Michael J Silverberg, Kaiser Permanente Northern California; John M Gill, Southern Alberta HIV Clinic; Heidi M Crane, University of Washington; Vincent Marconi, Emory University; Ronald J Bosch, Harvard University; Jonathan Colasanti, Emory University; Timothy R Sterling, Vanderbilt University; Christopher W Mathews, University of California San Diego; Angel M Mayor, Universidad Central del Caribe; Ni Gusti Ayu Nanditha, University of British Columbia; Kate Buchacz, Centers for Disease Control and Prevention, Atlanta; Jun Li, Centers for Disease Control and Prevention, Atlanta; Peter F Rebeiro, Vanderbilt University; Jennifer E Thorne, Johns Hopkins University; Ank Nijhawan, University of Texas Southwestern Medical Center; David van Duin, University of North Carolina; David A Wohl, University of North Carolina; Joseph J Eron, University of North Carolina; Stephn A Berry, Johns Hopkins University
• Language: English
• Date: 2021-06-15
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Final Published Version
• Copyright Statement: Published by Oxford University Press for the Infectious Diseases Society of America 2020.
• License: Creative Commons Universal : Public Domain Dedication
• Final Published Version (URL): http://dx.doi.org/10.1093/infdis/jiaa661
• Title of Journal or Parent Work: JOURNAL OF INFECTIOUS DISEASES
• Volume: 223
• Issue: 12
• Start Page: 2113
• End Page: 2123
• Grant/Funding Information: This work was supported by National Institutes of Health (grant numbers U01AI069918, F31AI124794, F31DA037788, G12MD007583, K01AI093197, K01AI131895, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050409, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01DA011602, R01DA012568, R01 AG053100, R24AI067039, U01AA013566, U01AA020790, U01AI038855, U01AI038858, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01DA03629, U01DA036935, U10EY008057, U10EY008052, U10EY008067, U01HL146192, U01HL146193, U01HL146194, U01HL146201, U01HL146202, U01HL146203, U01HL146204, U01HL146205, U01HL146208, U01HL146240, U01HL146241, U01HL146242, U01HL146245, U01HL146333, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, Z01CP010214, and Z01CP010176); Centers for Disease Control and Prevention (contract numbers CDC-200-2006-18797 and CDC-200-2015-63931); Agency for Healthcare Research and Quality (contract number 90047713); Health Resources and Services Administration (contract number 90051652); Canadian Institutes of Health Research (grant numbers CBR-86906, CBR-94036, HCP-97105, and TGF-96118); Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Additional support was provided by the National Institute of Allergy and Infectious Diseases (NIAID), National Cancer Institute, National Heart, Lung, and Blood Institute, Eunice Kennedy Shriver National Institute Of Child Health and Human Development, National Human Genome Research Institute, National Institute for Mental Health, National Institute on Drug Abuse (NIDA), National Institute on Aging, National Institute of Dental and Craniofacial Research, National Institute of Neurological Disorders and Stroke, National Institute of Nursing Research, National Institute on Alcohol Abuse and Alcoholism, National Institute on Deafness and Other Communication Disorders, and National Institute of Diabetes and Digestive and Kidney Diseases. T. D. M. has received training support from the NIAID (grant number T32AI007001) and the NIDA (grant number T32DA007250).
• Keywords: NORTH-AMERICA; MYOCARDIAL-INFARCTION; HIV; Life Sciences & Biomedicine; INFECTED INDIVIDUALS; Immunology; END; ADULTS; Science & Technology; COHORT; ANTIRETROVIRAL THERAPY; RISK; cohort studies; Microbiology; DISEASE; TRENDS; hospitalization; Infectious Diseases
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background: To assess the possible impact of antiretroviral therapy improvements, aging, and comorbidities, we examined trends in all-cause and cause-specific hospitalization rates among persons with HIV (PWH) from 2005 to 2015. Methods: In 6 clinical cohorts, we followed PWH in care (≥1 outpatient CD4 count or HIV load [VL] every 12 months) and categorized ICD codes of primary discharge diagnoses using modified Clinical Classifications Software. Poisson regression estimated hospitalization rate ratios for calendar time trends, adjusted for demographics, HIV risk factor, and annually updated age, CD4, and VL. Results: Among 28057 patients (125724 person-years), from 2005 to 2015, the median CD4 increased from 389 to 580 cells/μL and virologic suppression from 55% to 85% of patients. Unadjusted all-cause hospitalization rates decreased from 22.3 per 100 person-years in 2005 (95% confidence interval [CI], 20.6-24.1) to 13.0 in 2015 (95% CI, 12.2-14.0). Unadjusted rates decreased for almost all diagnostic categories. Adjusted rates decreased for all-cause, cardiovascular, and AIDS-defining conditions, increased for non-AIDS-defining infection, and were stable for most other categories. Conclusions: Among PWH with increasing CD4 counts and viral suppression, unadjusted hospitalization rates decreased for all-cause and most cause-specific hospitalizations, despite the potential effects of aging, comorbidities, and cumulative exposure to HIV and antiretrovirals.