Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005-2015

doi:10.1093/infdis/jiaa661

. 2021 Jun 15;223(12):2113-2123.

doi: 10.1093/infdis/jiaa661.

Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005-2015

Thibaut Davy-Mendez^{1

2}, Sonia Napravnik^{1

2}, Brenna C Hogan³, Keri N Althoff^{3

4}, Kelly A Gebo^{3

4}, Richard D Moore^{3

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 Wohl^{1

2}, Joseph J Eron^{1

2}, Stephen A Berry⁴; North American AIDS Cohort Collaboration on Research and Design of IeDEA

Collaborators, Affiliations

Collaborators

North American AIDS Cohort Collaboration on Research and Design of IeDEA:
Constance A Benson, Ronald J Bosch, Gregory D Kirk, Kenneth H Mayer, Chris Grasso, Robert S Hogg, P Richard Harrigan, Julio S G Montaner, Benita Yip, Julia Zhu, Kate Salters, Karyn Gabler, Kate Buchacz, Jun Li, Kelly A Gebo, Richard D Moore, Richard D Moore, John T Carey, Benigno Rodriguez, Michael A Horberg, Michael J Silverberg, Jennifer E Thorne, Todd Brown, Phyllis Tien, Gypsyamber D'Souza, Charles Rabkin, Marina B Klein, Abigail Kroch, Ann Burchell, Adrian Betts, Joanne Lindsay, Robert F Hunter-Mellado, Angel M Mayor, M John Gill, Jeffrey N Martin, Jun Li, John T Brooks, Michael S Saag, Michael J Mugavero, James Willig, William C Mathews, Joseph J Eron, Sonia Napravnik, Mari M Kitahata, Heidi M Crane, Timothy R Sterling, David Haas, Peter Rebeiro, Megan Turner, Janet Tate, Robert Dubrow, David Fiellin, Richard D Moore, Keri N Althoff, Stephen J Gange, Mari M Kitahata, Michael S Saag, Michael A Horberg, Marina B Klein, Rosemary G McKaig, Aimee M Freeman, Richard D Moore, Keri N Althoff, Aimee M Freeman, Mari M Kitahata, Stephen E Van Rompaey, Heidi M Crane, Liz Morton, Justin McReynolds, William B Lober, Stephen J Gange, Keri N Althoff, Jennifer S Lee, Bin You, Brenna Hogan, Jinbing Zhang, Jerry Jing, Elizabeth Humes, Lucas Gerace, Sally Coburn

Affiliations

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.

PMID: 33084891
PMCID: PMC8205637
DOI: 10.1093/infdis/jiaa661

Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005-2015

Thibaut Davy-Mendez et al. J Infect Dis. 2021.

. 2021 Jun 15;223(12):2113-2123.

doi: 10.1093/infdis/jiaa661.

Authors

Collaborators

North American AIDS Cohort Collaboration on Research and Design of IeDEA:
Constance A Benson, Ronald J Bosch, Gregory D Kirk, Kenneth H Mayer, Chris Grasso, Robert S Hogg, P Richard Harrigan, Julio S G Montaner, Benita Yip, Julia Zhu, Kate Salters, Karyn Gabler, Kate Buchacz, Jun Li, Kelly A Gebo, Richard D Moore, Richard D Moore, John T Carey, Benigno Rodriguez, Michael A Horberg, Michael J Silverberg, Jennifer E Thorne, Todd Brown, Phyllis Tien, Gypsyamber D'Souza, Charles Rabkin, Marina B Klein, Abigail Kroch, Ann Burchell, Adrian Betts, Joanne Lindsay, Robert F Hunter-Mellado, Angel M Mayor, M John Gill, Jeffrey N Martin, Jun Li, John T Brooks, Michael S Saag, Michael J Mugavero, James Willig, William C Mathews, Joseph J Eron, Sonia Napravnik, Mari M Kitahata, Heidi M Crane, Timothy R Sterling, David Haas, Peter Rebeiro, Megan Turner, Janet Tate, Robert Dubrow, David Fiellin, Richard D Moore, Keri N Althoff, Stephen J Gange, Mari M Kitahata, Michael S Saag, Michael A Horberg, Marina B Klein, Rosemary G McKaig, Aimee M Freeman, Richard D Moore, Keri N Althoff, Aimee M Freeman, Mari M Kitahata, Stephen E Van Rompaey, Heidi M Crane, Liz Morton, Justin McReynolds, William B Lober, Stephen J Gange, Keri N Althoff, Jennifer S Lee, Bin You, Brenna Hogan, Jinbing Zhang, Jerry Jing, Elizabeth Humes, Lucas Gerace, Sally Coburn

Affiliations

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.

PMID: 33084891
PMCID: PMC8205637
DOI: 10.1093/infdis/jiaa661

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.

Keywords: HIV; cohort studies; hospitalization.

Published by Oxford University Press for the Infectious Diseases Society of America 2020.

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Figures

**Figure 1.**
A–D, Unadjusted annual all-cause and cause-specific hospitalization rates with 95% confidence bands, among 28 057 patients in HIV care in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), 2005–2015. Shown are the 10 most common diagnostic categories ordered by frequency.

**Figure 2.**
A–D, Annual all-cause and cause-specific hospitalization rates, among 28 057 patients in HIV care in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), 2005–2015, standardized to age, CD4 count, and HIV load distribution of person-years in 2010. Standardization strata were defined according to the following categories: age <40, 40–49, 50–59, and ≥60 years; CD4 count <50, 50–200, 201–350, 351–500, and >500 cells/μL; HIV load <400 and ≥400 copies/mL. Shown are the 10 most common diagnostic categories ordered by frequency.

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References

1. Thompson MA, Aberg JA, Hoy JF, et al. . Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel. JAMA 2012; 308:387–402. - PubMed
1. Hanna DB, Buchacz K, Gebo KA, et al. . Trends and disparities in antiretroviral therapy initiation and virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001–2009. Clin Infect Dis 2013; 56:1174–82. - PMC - PubMed
1. Nance RM, Delaney JAC, Simoni JM, et al. . HIV viral suppression trends over time among HIV-infected patients receiving care in the United States, 1997 to 2015: a cohort study. Ann Intern Med 2018; 169:376–84. - PMC - PubMed
1. Samji H, Cescon A, Hogg RS, et al. . Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One 2013; 8:e81355. - PMC - PubMed
1. Centers for Disease Control and Prevention. HIV among people aged 50 and over. https://www.cdc.gov/hiv/group/age/olderamericans/index.html. Accessed 12 June 2019.

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[1] Thompson MA, Aberg JA, Hoy JF, et al. . Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel. JAMA 2012; 308:387–402. - PubMed

[2] Thompson MA, Aberg JA, Hoy JF, et al. . Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel. JAMA 2012; 308:387–402. - PubMed

[3] Hanna DB, Buchacz K, Gebo KA, et al. . Trends and disparities in antiretroviral therapy initiation and virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001–2009. Clin Infect Dis 2013; 56:1174–82. - PMC - PubMed

[4] Hanna DB, Buchacz K, Gebo KA, et al. . Trends and disparities in antiretroviral therapy initiation and virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001–2009. Clin Infect Dis 2013; 56:1174–82. - PMC - PubMed

[5] Nance RM, Delaney JAC, Simoni JM, et al. . HIV viral suppression trends over time among HIV-infected patients receiving care in the United States, 1997 to 2015: a cohort study. Ann Intern Med 2018; 169:376–84. - PMC - PubMed

[6] Nance RM, Delaney JAC, Simoni JM, et al. . HIV viral suppression trends over time among HIV-infected patients receiving care in the United States, 1997 to 2015: a cohort study. Ann Intern Med 2018; 169:376–84. - PMC - PubMed

[7] Samji H, Cescon A, Hogg RS, et al. . Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One 2013; 8:e81355. - PMC - PubMed

[8] Samji H, Cescon A, Hogg RS, et al. . Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One 2013; 8:e81355. - PMC - PubMed

[9] Centers for Disease Control and Prevention. HIV among people aged 50 and over. https://www.cdc.gov/hiv/group/age/olderamericans/index.html. Accessed 12 June 2019.

[10] Centers for Disease Control and Prevention. HIV among people aged 50 and over. https://www.cdc.gov/hiv/group/age/olderamericans/index.html. Accessed 12 June 2019.

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Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005-2015

Collaborators

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Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005-2015

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