Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005-2015.
HIV
cohort studies
hospitalization
Journal
The Journal of infectious diseases
ISSN: 1537-6613
Titre abrégé: J Infect Dis
Pays: United States
ID NLM: 0413675
Informations de publication
Date de publication:
15 06 2021
15 06 2021
Historique:
received:
14
08
2020
accepted:
15
10
2020
pubmed:
22
10
2020
medline:
15
2
2022
entrez:
21
10
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 33084891
pii: 5934541
doi: 10.1093/infdis/jiaa661
pmc: PMC8205637
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
2113-2123Subventions
Organisme : NIDA NIH HHS
ID : F31 DA037788
Pays : United States
Organisme : NIDA NIH HHS
ID : K24 DA000432
Pays : United States
Organisme : CIHR
ID : CBR-94036
Pays : Canada
Organisme : CIHR
ID : HCP-97105
Pays : Canada
Organisme : NHLBI NIH HHS
ID : U01 HL146241
Pays : United States
Organisme : CIHR
ID : TGF-96118
Pays : Canada
Organisme : NHLBI NIH HHS
ID : U01 HL146193
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI050409
Pays : United States
Organisme : NCI NIH HHS
ID : N01 CP001004
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA012568
Pays : United States
Organisme : NIAAA NIH HHS
ID : U01 AA020790
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI068636
Pays : United States
Organisme : NIMH NIH HHS
ID : P30 MH062246
Pays : United States
Organisme : NEI NIH HHS
ID : U10 EY008057
Pays : United States
Organisme : NIDA NIH HHS
ID : U01 DA036935
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI038855
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI050410
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146194
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069432
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG053100
Pays : United States
Organisme : NIAID NIH HHS
ID : F31 AI124794
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146202
Pays : United States
Organisme : NIAAA NIH HHS
ID : U24 AA020794
Pays : United States
Organisme : NIMHD NIH HHS
ID : G12 MD007583
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NEI NIH HHS
ID : U10 EY008052
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146245
Pays : United States
Organisme : NIAAA NIH HHS
ID : U01 AA013566
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146205
Pays : United States
Organisme : NEI NIH HHS
ID : U10 EY008067
Pays : United States
Organisme : NIAID NIH HHS
ID : K01 AI093197
Pays : United States
Organisme : NIMHD NIH HHS
ID : U54 MD007587
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI027767
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146333
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146240
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI038858
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA011602
Pays : United States
Organisme : NIAID NIH HHS
ID : K24 AI065298
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146242
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI027757
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI068634
Pays : United States
Organisme : NIAID NIH HHS
ID : K24 AI118591
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI110527
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI007001
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146204
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069434
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146192
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000083
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI027763
Pays : United States
Organisme : NIAAA NIH HHS
ID : R01 AA016893
Pays : United States
Organisme : CIHR
ID : CBR-86906
Pays : Canada
Organisme : NHLBI NIH HHS
ID : U01 HL146208
Pays : United States
Organisme : NIDA NIH HHS
ID : T32 DA007250
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR002317
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146201
Pays : United States
Organisme : NIAID NIH HHS
ID : K01 AI131895
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069918
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146203
Pays : United States
Organisme : NEI NIH HHS
ID : K23 EY013707
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI094189
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000004
Pays : United States
Organisme : Intramural NIH HHS
ID : Z01 CP010176
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR000421
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI036219
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI068634
Pays : United States
Organisme : NIAID NIH HHS
ID : R24 AI067039
Pays : United States
Investigateurs
Constance A Benson
(CA)
Ronald J Bosch
(RJ)
Gregory D Kirk
(GD)
Kenneth H Mayer
(KH)
Chris Grasso
(C)
Robert S Hogg
(RS)
P Richard Harrigan
(PR)
Julio S G Montaner
(JSG)
Benita Yip
(B)
Julia Zhu
(J)
Kate Salters
(K)
Karyn Gabler
(K)
Kate Buchacz
(K)
Jun Li
(J)
Kelly A Gebo
(KA)
Richard D Moore
(RD)
Richard D Moore
(RD)
John T Carey
(JT)
Benigno Rodriguez
(B)
Michael A Horberg
(MA)
Michael J Silverberg
(MJ)
Jennifer E Thorne
(JE)
Todd Brown
(T)
Phyllis Tien
(P)
Gypsyamber D'Souza
(G)
Charles Rabkin
(C)
Marina B Klein
(MB)
Abigail Kroch
(A)
Ann Burchell
(A)
Adrian Betts
(A)
Joanne Lindsay
(J)
Robert F Hunter-Mellado
(RF)
Angel M Mayor
(AM)
M John Gill
(M)
Jeffrey N Martin
(JN)
Jun Li
(J)
John T Brooks
(JT)
Michael S Saag
(MS)
Michael J Mugavero
(MJ)
James Willig
(J)
William C Mathews
(WC)
Joseph J Eron
(JJ)
Sonia Napravnik
(S)
Mari M Kitahata
(MM)
Heidi M Crane
(HM)
Timothy R Sterling
(TR)
David Haas
(D)
Peter Rebeiro
(P)
Megan Turner
(M)
Janet Tate
(J)
Robert Dubrow
(R)
David Fiellin
(D)
Richard D Moore
(RD)
Keri N Althoff
(KN)
Stephen J Gange
(SJ)
Mari M Kitahata
(MM)
Michael S Saag
(MS)
Michael A Horberg
(MA)
Marina B Klein
(MB)
Rosemary G McKaig
(RG)
Aimee M Freeman
(AM)
Richard D Moore
(RD)
Keri N Althoff
(KN)
Aimee M Freeman
(AM)
Mari M Kitahata
(MM)
Stephen E Van Rompaey
(SE)
Heidi M Crane
(HM)
Liz Morton
(L)
Justin McReynolds
(J)
William B Lober
(WB)
Stephen J Gange
(SJ)
Keri N Althoff
(KN)
Jennifer S Lee
(JS)
Bin You
(B)
Brenna Hogan
(B)
Jinbing Zhang
(J)
Jerry Jing
(J)
Elizabeth Humes
(E)
Lucas Gerace
(L)
Sally Coburn
(S)
Informations de copyright
Published by Oxford University Press for the Infectious Diseases Society of America 2020.
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