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

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 outp...

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Bibliographic Details
Published in:The Journal of infectious diseases 2021-06, Vol.223 (12), p.2113-2123
Main Authors: Davy-Mendez, Thibaut, Napravnik, Sonia, Hogan, Brenna C, Althoff, Keri N, Gebo, Kelly A, Moore, Richard D, Horberg, Michael A, Silverberg, Michael J, Gill, M John, Crane, Heidi M, Marconi, Vincent C, Bosch, Ronald J, Colasanti, Jonathan A, Sterling, Timothy R, Mathews, W Christopher, Mayor, Angel M, Nanditha, Ni Gusti Ayu, Buchacz, Kate, Li, Jun, Rebeiro, Peter F, Thorne, Jennifer E, Nijhawan, Ank, van Duin, David, Wohl, David A, Eron, Joseph J, Berry, Stephen A
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Acquired Immunodeficiency Syndrome - drug therapy
Acquired Immunodeficiency Syndrome - epidemiology
Aging
AIDS
Anti-HIV Agents - therapeutic use
Antiretroviral drugs
Antiretroviral therapy
Antiviral agents
Canada - epidemiology
CD4 antigen
CD4 Lymphocyte Count
Cohort analysis
Comorbidity
Demography
Editor's Choice
HIV
HIV Infections - drug therapy
HIV Infections - epidemiology
Hospitalization
Hospitalization - statistics & numerical data
Human immunodeficiency virus
Humans
Major and Brief Reports
Patients
Risk Factors
Trends
United States - epidemiology
Viral Load
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Summary: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. From 2005 to 2015, in 6 US and Canadian clinical cohorts of persons with HIV with increasing age, viral suppression, and CD4 counts, unadjusted hospitalization rates decreased overall and for most causes.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/jiaa661