Current and Past Immunodeficiency Are Associated With Higher Hospitalization Rates Among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years
Author:
Davy-Mendez Thibaut12ORCID, Napravnik Sonia12, Eron Joseph J12, Cole Stephen R1, van Duin David2ORCID, Wohl David A12, Hogan Brenna C3, Althoff Keri N34, Gebo Kelly A34, Moore Richard D34, Silverberg Michael J5ORCID, Horberg Michael A6, Gill M John7, Mathews W Christopher8, Klein Marina B9, Colasanti Jonathan A10, Sterling Timothy R11, Mayor Angel M12, Rebeiro Peter F11ORCID, Buchacz Kate13, Li Jun13, Nanditha Ni Gusti Ayu14, Thorne Jennifer E4, Nijhawan Ank15, Berry Stephen A4, Benson Constance A, Bosch Ronald J, Kirk Gregory D, Mayer Kenneth H, Grasso Chris, Hogg Robert S, Montaner Julio S G, Salters Kate, Lima Viviane D, Sereda Paul, Trigg Jason, Buchacz Kate, Li Jun, Gebo Kelly A, Moore Richard D, Moore Richard D, Rodriguez Benigno, Horberg Michael A, Silverberg Michael J, Thorne Jennifer E, Brown Todd, Tien Phyllis, D’Souza Gypsyamber, Rabkin Charles, Klein Marina B, Kroch Abigail, Burchell Ann, Betts Adrian, Lindsay oanne, Hunter-Mellado Robert F, Mayor Angel M, Gill M John, Martin Jeffrey N, Li Jun, Brooks John T, Saag Michael S, Mugavero Michael J, Willig James, Mathews William C, Eron Joseph J, Napravnik Sonia, Kitahata Mari M, Crane Heidi M, Sterling Timothy R, Haas David, Rebeiro Peter, Turner Megan, Tate Janet, Dubrow Robert, Fiellin David, Moore Richard D, Althoff Keri N, Gange Stephen J, Kitahata Mari M, Saag Michael S, Horberg Michael A, Klein Marina B, McKaig Rosemary G, Freeman Aimee M, Moore Richard D, Althoff Keri N, Freeman Aimee M, Kitahata Mari M, Van Rompaey Stephen E, Crane Heidi M, Morton Liz, McReynolds Justin, Lober William B, Gange Stephen J, Althoff Keri N, Lee Jennifer S, You Bin, Hogan Brenna, Zhang Jinbing, Jing Jerry, Humes Elizabeth, Gerace Lucas, Coburn Sally,
Affiliation:
1. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 2. School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 3. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA 4. School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA 5. Kaiser Permanente Northern California, Oakland, California, USA 6. Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA 7. Southern Alberta HIV Clinic, Calgary, Alberta, Canada 8. School of Medicine, University of California, San Diego, San Diego, California, USA 9. Faculty of Medicine, McGill University, Montreal, Quebec, Canada 10. School of Medicine, Emory University, Atlanta, Georgia, USA 11. School of Medicine, Vanderbilt University, Nashville, Tennessee, USA 12. School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico, USA 13. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 14. Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada 15. University of Texas Southwestern Medical Center, Dallas, Texas, USA
Abstract
Abstract
Background
Persons with human immunodeficiency virus (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk.
Methods
In 6 US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005–2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (years 2–5) and long-term (years 6–11) suppression and lowest presuppression CD4 count <200 and ≥200 cells/µL, Poisson regression models estimated hospitalization incidence rate ratios (aIRRs) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest presuppression CD4 count.
Results
The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% white. Among patients with lowest presuppression CD4 count <200 cells/μL (44%), patients with current CD4 count 200–350 vs >500 cells/μL had aIRRs of 1.44 during early suppression (95% confidence interval [CI], 1.01–2.06), and 1.67 (95% CI, 1.03–2.72) during long-term suppression. Among patients with lowest presuppression CD4 count ≥200 (56%), patients with current CD4 351–500 vs >500 cells/μL had an aIRR of 1.22 (95% CI, .93–1.60) during early suppression and 2.09 (95% CI, 1.18–3.70) during long-term suppression.
Conclusions
Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates and could potentially benefit from targeted clinical management strategies.
Funder
National Institute of Allergy and Infectious Diseases National Institute on Drug Abuse NIH CDC Agency for Healthcare Research and Quality Health Resources and Services Administration Canadian Institutes of Health Research 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 of Mental Health 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 National Institute of Diabetes and Digestive and Kidney Diseases
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Immunology and Allergy
Reference43 articles.
1. Trends in reasons for hospitalization in a multisite United States cohort of persons living with HIV, 2001–2008;Berry;J Acquir Immune Defic Syndr,2012 2. U.S. hospitalization rates and reasons stratified by age among persons with HIV 2014–15;Fleming;AIDS Care,2019 3. Hospitalization rates and causes among persons with HIV in the US and Canada, 2005–2015 [manuscript published online ahead of print 21 October 2020];Davy-Mendez,2020
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