Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005–2015
Author:
Davy-Mendez Thibaut12ORCID, Napravnik Sonia12, Hogan Brenna C3, Althoff Keri N34, Gebo Kelly A34, Moore Richard D34, Horberg Michael A5, Silverberg Michael J6ORCID, Gill M John7, Crane Heidi M8, Marconi Vincent C9, Bosch Ronald J10, Colasanti Jonathan A9, Sterling Timothy R11, Mathews W Christopher12, Mayor Angel M13, Nanditha Ni Gusti Ayu14, Buchacz Kate15, Li Jun15, Rebeiro Peter F11ORCID, Thorne Jennifer E4, Nijhawan Ank16, van Duin David2ORCID, Wohl David A12, Eron Joseph J12, Berry Stephen A4, Benson Constance A, Bosch Ronald J, Kirk Gregory D, Mayer Kenneth H, Grasso Chris, Hogg Robert S, Harrigan P Richard, Montaner Julio S G, Yip Benita, Zhu Julia, Salters Kate, Gabler Karyn, Buchacz Kate, Li Jun, Gebo Kelly A, Moore Richard D, Moore Richard D, Carey John T, 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 Joanne, Hunter-Mellado Robert F, Mayor Angel M, John Gill M, 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 Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA 6. Kaiser Permanente Northern California, Oakland, California, USA 7. Southern Alberta HIV Clinic, Calgary, Alberta, Canada 8. School of Medicine, University of Washington, Seattle, Washington, USA 9. School of Medicine, Emory University, Atlanta, Georgia, USA 10. T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA 11. School of Medicine, Vanderbilt University, Nashville, Tennessee, USA 12. School of Medicine, University of California San Diego, San Diego, California, USA 13. School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico, USA 14. Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada 15. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 16. University of Texas Southwestern Medical Center, Dallas, Texas, USA
Abstract
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 28 057 patients (125 724 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.
Funder
National Institutes of Health Centers for Disease Control and Prevention Agency for Healthcare Research and Quality Health Resources and Services Administration Canadian Institutes of Health Research Ontario Ministry of Health and Long Term Care Government of Alberta National Institute of Allergy and Infectious Diseases 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 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
Cited by
10 articles.
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