Hospitalization Rates and Outcomes Among Persons Living With Human Immunodeficiency Virus in the Southeastern United States, 1996-2016

Abstract

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.

Keywords: HIV; clinical cohort; hospital readmission; hospitalization; length of stay.

Figure 1.

Annual hospitalization rates and mean rate change, 1996–2016, for all-cause hospitalizations (blue) and hospitalizations with CD4 count <100 cells/µL (red) among all patients (A), black patients (B), white patients (C), women (D), men who have sex with men (E), heterosexual men (F), patients aged <50 years (G), and patients aged ≥50 years (H). Mean annual rate change was estimated using Poisson regression models. In the absence of discharge diagnosis data, a CD4 count <100 cells/µL, measured in the 9 months prior to hospitalization, was used as an indicator that hospitalization was likely AIDS related. Abbreviation: CI, confidence interval.