BACKGROUND: Antiretroviral therapy (ART) advances, aging, and comorbidities impact hospitalizations in human immunodeficiency virus (HIV)-positive populations. We examined temporal trends and patient characteristics associated with hospitalization rates and outcomes. METHODS: Among patients in the University of North Carolina Center for AIDS Research HIV Clinical Cohort receiving care during 1996-2016, we estimated annual hospitalization rates, time to inpatient mortality or live discharge, and 30-day readmission risk using bivariable Poisson, Fine-Gray, and log-binomial regression models. RESULTS: The 4323 included patients (29% women, 60% African American) contributed 30 007 person-years. Overall, the hospitalization rate per 100 person-years was 34.3 (95% confidence interval [CI], 32.4-36.4) with a mean annual change of -3% (95% CI, -4% to -2%). Patients who were black (vs white), older, had HIV RNA >400 copies/mL, or had CD4 count <200 cells/μL had higher hospitalization rates (all P < .05). Thirty-day readmission risk was 18.9% (95% CI, 17.7%-20.2%), stable over time (P > .05 for both 2010-2016 and 2003-2009 vs 1996-2002), and higher among black patients, those with detectable HIV RNA, and those with lower CD4 cell counts (all P < .05). Higher inpatient mortality was associated with older age and lower CD4 cell count (both P < .05). CONCLUSIONS: Hospitalization rates decreased from 1996 to 2016, but high readmissions persisted. Older patients, those of minority race/ethnicity, and those with uncontrolled HIV experienced higher rates and worse hospitalization outcomes. These findings underscore the importance of early ART and care engagement, particularly at hospital discharge.
BACKGROUND: Antiretroviral therapy (ART) advances, aging, and comorbidities impact hospitalizations in human immunodeficiency virus (HIV)-positive populations. We examined temporal trends and patient characteristics associated with hospitalization rates and outcomes. METHODS: Among patients in the University of North Carolina Center for AIDS Research HIV Clinical Cohort receiving care during 1996-2016, we estimated annual hospitalization rates, time to inpatient mortality or live discharge, and 30-day readmission risk using bivariable Poisson, Fine-Gray, and log-binomial regression models. RESULTS: The 4323 included patients (29% women, 60% African American) contributed 30 007 person-years. Overall, the hospitalization rate per 100 person-years was 34.3 (95% confidence interval [CI], 32.4-36.4) with a mean annual change of -3% (95% CI, -4% to -2%). Patients who were black (vs white), older, had HIV RNA >400 copies/mL, or had CD4 count <200 cells/μL had higher hospitalization rates (all P < .05). Thirty-day readmission risk was 18.9% (95% CI, 17.7%-20.2%), stable over time (P > .05 for both 2010-2016 and 2003-2009 vs 1996-2002), and higher among black patients, those with detectable HIV RNA, and those with lower CD4 cell counts (all P < .05). Higher inpatient mortality was associated with older age and lower CD4 cell count (both P < .05). CONCLUSIONS: Hospitalization rates decreased from 1996 to 2016, but high readmissions persisted. Older patients, those of minority race/ethnicity, and those with uncontrolled HIV experienced higher rates and worse hospitalization outcomes. These findings underscore the importance of early ART and care engagement, particularly at hospital discharge.
Authors: Katherine W Kooij; Ferdinand W N M Wit; Judith Schouten; Marc van der Valk; Mieke H Godfried; Ineke G Stolte; Maria Prins; Julian Falutz; Peter Reiss Journal: AIDS Date: 2016-01 Impact factor: 4.177
Authors: Alison G Abraham; Keri N Althoff; Yuezhou Jing; Michelle M Estrella; Mari M Kitahata; C William Wester; Ronald J Bosch; Heidi Crane; Joseph Eron; M John Gill; Michael A Horberg; Amy C Justice; Marina Klein; Angel M Mayor; Richard D Moore; Frank J Palella; Chirag R Parikh; Michael J Silverberg; Elizabeth T Golub; Lisa P Jacobson; Sonia Napravnik; Gregory M Lucas Journal: Clin Infect Dis Date: 2014-11-18 Impact factor: 9.079
Authors: Kathleen Falster; Handan Wand; Basil Donovan; Jonathan Anderson; David Nolan; Kerrie Watson; Jo Watson; Matthew G Law Journal: AIDS Date: 2010-06-01 Impact factor: 4.177
Authors: Jens D Lundgren; Abdel G Babiker; Fred Gordin; Sean Emery; Birgit Grund; Shweta Sharma; Anchalee Avihingsanon; David A Cooper; Gerd Fätkenheuer; Josep M Llibre; Jean-Michel Molina; Paula Munderi; Mauro Schechter; Robin Wood; Karin L Klingman; Simon Collins; H Clifford Lane; Andrew N Phillips; James D Neaton Journal: N Engl J Med Date: 2015-07-20 Impact factor: 91.245
Authors: C A Kleeberger; J P Phair; S A Strathdee; R Detels; L Kingsley; L P Jacobson Journal: J Acquir Immune Defic Syndr Date: 2001-01-01 Impact factor: 3.731
Authors: Kate Buchacz; Rose K Baker; Anne C Moorman; James T Richardson; Kathleen C Wood; Scott D Holmberg; John T Brooks Journal: AIDS Date: 2008-07-11 Impact factor: 4.177
Authors: Thibaut Davy-Mendez; Sonia Napravnik; Joseph J Eron; Stephen R Cole; David van Duin; David A Wohl; Brenna C Hogan; Keri N Althoff; Kelly A Gebo; Richard D Moore; Michael J Silverberg; Michael A Horberg; M John Gill; W Christopher Mathews; Marina B Klein; Jonathan A Colasanti; Timothy R Sterling; Angel M Mayor; Peter F Rebeiro; Kate Buchacz; Jun Li; Ni Gusti Ayu Nanditha; Jennifer E Thorne; Ank Nijhawan; Stephen A Berry Journal: J Infect Dis Date: 2020-12-26 Impact factor: 5.226
Authors: Sophia M Rein; Colette J Smith; Clinton Chaloner; Adam Stafford; Alison J Rodger; Margaret A Johnson; Jeffrey McDonnell; Fiona Burns; Sara Madge; Alec Miners; Lorraine Sherr; Simon Collins; Andrew Speakman; Andrew N Phillips; Fiona C Lampe Journal: EClinicalMedicine Date: 2020-12-01
Authors: Abhishek Verma; Ashley M Hine; Andrew Joelson; Rena Mei; Robert A Pitts; Benjamin Lebwohl; Jordan E Axelrad Journal: Therap Adv Gastroenterol Date: 2022-04-28 Impact factor: 4.802
Authors: Kellee English; Sarah B May; Jessica A Davila; Jeffrey A Cully; Lilian Dindo; K Rivet Amico; Michael A Kallen; Thomas P Giordano Journal: Open Forum Infect Dis Date: 2020-05-26 Impact factor: 3.835
Authors: Sophia M Rein; Fiona C Lampe; Clinton Chaloner; Adam Stafford; Alison J Rodger; Margaret A Johnson; Jeffrey McDonnell; Fiona Burns; Sara Madge; Alec Miners; Lorraine Sherr; Simon Collins; Andrew Speakman; Andrew N Phillips; Colette J Smith Journal: BMC Infect Dis Date: 2021-04-29 Impact factor: 3.090
Authors: Thibaut Davy-Mendez; Sonia Napravnik; Brenna C Hogan; Keri N Althoff; Kelly A Gebo; Richard D Moore; Michael A Horberg; Michael J Silverberg; M John Gill; Heidi M Crane; Vincent C Marconi; Ronald J Bosch; Jonathan A Colasanti; Timothy R Sterling; W Christopher Mathews; Angel M Mayor; Ni Gusti Ayu Nanditha; Kate Buchacz; Jun Li; Peter F Rebeiro; Jennifer E Thorne; Ank Nijhawan; David van Duin; David A Wohl; Joseph J Eron; Stephen A Berry Journal: J Infect Dis Date: 2021-06-15 Impact factor: 5.226