Longitudinal assessment (1995-2003) of hospitalizations of HIV-infected patients within a geographical population in Canada.

OBJECTIVES: To determine the frequency of and reasons for hospitalization of adult HIV-infected patients compared with the general population.
METHODS: Length of stay, primary/secondary diagnoses and discharge status were reviewed for all HIV-infected patients admitted to Calgary-area hospitals between 1995 and 2003. Admissions were classified as HIV- or non-HIV-related using International Classification of Diseases, 9th and 10th revisions (ICD-9/10) codes and confirmed by chart review. Summary comparative data on admissions for the general population were obtained from the regional administrative database.
RESULTS: HIV-infected adults were hospitalized more than twice as frequently, experienced longer stays (median length 5 vs 3 days, respectively) and had higher in-hospital mortality rates (9.1 vs 1.3 per 100 admissions, respectively) than the general population (P < 0.01). Hospitalizations of HIV-infected patients declined by 58% from 1995 to 2003. Patients newly diagnosed with HIV infection accounted for 15% of all HIV-related hospitalizations. HIV-related admissions for known HIV-infected patients decreased from 12 per 100 patient-years-followed in 1995 to 3 per 100 patient-years-followed in 2003. Low CD4 counts, AIDS, and no current use of highly active antiretroviral therapy (HAART) were strongly correlated with hospitalizations (P < 0.01). Non-HIV-related hospitalizations for HIV-infected patients increased by 42% and were associated with comorbidities (e.g. substance use and psychological disorders).
CONCLUSION: Despite the reduction in HIV-related hospitalizations following the introduction of HAART, all-cause hospitalization rates have increased and have started to erode this benefit.