Thibaut Davy-Mendez1,2, Sonia Napravnik1,2, Joseph J Eron1,2, Stephen R Cole1, David van Duin2, David A Wohl1,2, Brenna C Hogan3, Keri N Althoff3,4, Kelly A Gebo3,4, Richard D Moore3,4, Michael J Silverberg5, Michael A Horberg6, M John Gill7, W Christopher Mathews8, Marina B Klein9, Jonathan A Colasanti10, Timothy R Sterling11, Angel M Mayor12, Peter F Rebeiro11, Kate Buchacz13, Jun Li13, Ni Gusti Ayu Nanditha14, Jennifer E Thorne4, Ank Nijhawan15, 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 Northern California, Oakland, California, USA. 6. Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA. 7. Southern Alberta HIV Clinic, Calgary, Alberta, Canada. 8. School of Medicine, University of California, San Diego, San Diego, California, USA. 9. Faculty of Medicine, McGill University, Montreal, Quebec, Canada. 10. School of Medicine, Emory University, Atlanta, Georgia, USA. 11. School of Medicine, Vanderbilt University, Nashville, Tennessee, USA. 12. School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico, USA. 13. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 14. Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 15. University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Abstract
BACKGROUND: Persons with human immunodeficiency virus (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk. METHODS: In 6 US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (years 2-5) and long-term (years 6-11) suppression and lowest presuppression CD4 count <200 and ≥200 cells/µL, Poisson regression models estimated hospitalization incidence rate ratios (aIRRs) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest presuppression CD4 count. RESULTS: The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% white. Among patients with lowest presuppression CD4 count <200 cells/μL (44%), patients with current CD4 count 200-350 vs >500 cells/μL had aIRRs of 1.44 during early suppression (95% confidence interval [CI], 1.01-2.06), and 1.67 (95% CI, 1.03-2.72) during long-term suppression. Among patients with lowest presuppression CD4 count ≥200 (56%), patients with current CD4 351-500 vs >500 cells/μL had an aIRR of 1.22 (95% CI, .93-1.60) during early suppression and 2.09 (95% CI, 1.18-3.70) during long-term suppression. CONCLUSIONS: Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates and could potentially benefit from targeted clinical management strategies.
BACKGROUND: Persons with human immunodeficiency virus (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk. METHODS: In 6 US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (years 2-5) and long-term (years 6-11) suppression and lowest presuppression CD4 count <200 and ≥200 cells/µL, Poisson regression models estimated hospitalization incidence rate ratios (aIRRs) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest presuppression CD4 count. RESULTS: The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% white. Among patients with lowest presuppression CD4 count <200 cells/μL (44%), patients with current CD4 count 200-350 vs >500 cells/μL had aIRRs of 1.44 during early suppression (95% confidence interval [CI], 1.01-2.06), and 1.67 (95% CI, 1.03-2.72) during long-term suppression. Among patients with lowest presuppression CD4 count ≥200 (56%), patients with current CD4 351-500 vs >500 cells/μL had an aIRR of 1.22 (95% CI, .93-1.60) during early suppression and 2.09 (95% CI, 1.18-3.70) during long-term suppression. CONCLUSIONS: Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates and could potentially benefit from targeted clinical management strategies.
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