National Hospitalization Rates and In-Hospital Mortality Rates of HIV–Related Opportunistic Infections in the United States, 2011–2018

Abstract

Abstract Background Human immunodeficiency virus (HIV)–related opportunistic infections (OIs) cause substantial morbidity and mortality among people with HIV (PWH). US hospitalization and in-hospital mortality rates associated with OIs have not been published using data from the past decade. Methods We analyzed the National Inpatient Sample for the years 2011 through 2018. We used sociodemographic, financial, and hospital-level variables and identified hospitalizations for PWH and OI diagnoses. Using survey-weighted methods, we estimated all OI-related US hospitalization rates and in-hospital mortality per 100 000 PWH and modeled associated factors using survey-based multivariable logistic regression techniques. Results From 2011 to 2018, there were an estimated 1 710 164 (95% confidence interval [CI], 1 659 566–1 760 762) hospital discharges for PWH with 154 430 (95% CI, 148 669–159 717 [9.2%]) associated with an OI, of which 9336 (95% CI, 8813–9857; 6.0%) resulted in in-hospital mortality. Variables associated with higher odds of OI-related hospitalizations (compared to without an OI) included younger age, male sex, non-White race/ethnicity, and being uninsured (all likelihood ratio [LR] P < .001). Higher OI-related mortality was associated with older age (LR P < .001), male sex (LR P = .001), Hispanic race/ethnicity (LR P < .001), and being uninsured (LR P = .009). The OI-related hospitalization rate fell from 2725.3 (95% CI, 2266.9–3183.7) per 100 000 PWH in 2011 to 1647.3 (95% CI, 1492.5–1802.1) in 2018 (P < .001), but the proportion of hospitalizations with mortality was stable (5.9% in 2011 and 2018). Conclusions Our findings indicate an ongoing need for continued funding of HIV testing, health insurance for all PWH, OI screening initiatives, review of current prophylaxis guidelines, and recruitment of more HIV clinicians.