Thibaut Davy-Mendez1,2, Sonia Napravnik1,2, Brenna C Hogan3, Keri N Althoff3,4, Kelly A Gebo3,4, Richard D Moore3,4, Michael A Horberg5, Michael J Silverberg6, M John Gill7, Heidi M Crane8, Vincent C Marconi9, Ronald J Bosch10, Jonathan A Colasanti9, Timothy R Sterling11, W Christopher Mathews12, Angel M Mayor13, Ni Gusti Ayu Nanditha14, Kate Buchacz15, Jun Li15, Peter F Rebeiro11, Jennifer E Thorne4, Ank Nijhawan16, David van Duin2, David A Wohl1,2, Joseph J Eron1,2, Stephen A Berry4. 1. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 2. School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 3. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. 4. School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. 5. Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA. 6. Kaiser Permanente Northern California, Oakland, California, USA. 7. Southern Alberta HIV Clinic, Calgary, Alberta, Canada. 8. School of Medicine, University of Washington, Seattle, Washington, USA. 9. School of Medicine, Emory University, Atlanta, Georgia, USA. 10. T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA. 11. School of Medicine, Vanderbilt University, Nashville, Tennessee, USA. 12. School of Medicine, University of California San Diego, San Diego, California, USA. 13. School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico, USA. 14. Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 15. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 16. University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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. Published by Oxford University Press for the Infectious Diseases Society of America 2020.
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. Published by Oxford University Press for the Infectious Diseases Society of America 2020.
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