Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 16;224(4):657-666.
doi: 10.1093/infdis/jiaa786. Epub 2020 Dec 26.

Current and Past Immunodeficiency Are Associated With Higher Hospitalization Rates Among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years

Thibaut Davy-Mendez  1   2 , Sonia Napravnik  1   2 , Joseph J Eron  1   2 , Stephen R Cole  1 , David van Duin  2 , David A Wohl  1   2 , Brenna C Hogan  3 , Keri N Althoff  3   4 , Kelly A Gebo  3   4 , Richard D Moore  3   4 , Michael J Silverberg  5 , Michael A Horberg  6 , M John Gill  7 , W Christopher Mathews  8 , Marina B Klein  9 , Jonathan A Colasanti  10 , Timothy R Sterling  11 , Angel M Mayor  12 , Peter F Rebeiro  11 , Kate Buchacz  13 , Jun Li  13 , Ni Gusti Ayu Nanditha  14 , Jennifer E Thorne  4 , Ank Nijhawan  15 , Stephen A Berry  4 ; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiology Databases to Evaluate AIDS (IeDEA)
Collaborators, Affiliations

Current and Past Immunodeficiency Are Associated With Higher Hospitalization Rates Among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years

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

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.

Keywords: CD4 lymphocyte count; HIV; cohort studies; hospitalization; sustained virologic response.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flowchart of patient inclusion and follow-up. Abbreviations: ART, antiretroviral therapy; LTFU, loss to follow-up; VL, viral load.
Figure 2.
Figure 2.
CD4 cell count distribution from the first human immunodeficiency virus RNA load <400 copies/mL to year 10 of sustained virologic suppression, among patients with a lowest presuppression CD4 count <200 cells/µL (A) or ≥200 cells/µL (B). Shown are the median (solid line), interquartile range (band), and 5th and 95th percentiles (dashed lines). CD4 counts are 24-month weighted moving averages of up to 3 measurements, updated every 6 months of virologic suppression. Values for year 11 are not displayed due to small sample sizes.
Figure 3.
Figure 3.
Unadjusted all-cause hospitalization rates by CD4 cell count category, stratified by early (years 2–5) or long-term (years 6–11) virologic suppression, among patients with a lowest presuppression CD4 count <200 cells/µL (A) or ≥200 cells/µL (B). Error bars are the 95% confidence intervals. Rates were not estimated for categories with <100 person-years. CD4 counts are 24-month weighted moving averages of up to 3 measurements, updated every 6 months of virologic suppression.
See this image and copyright information in PMC

References

    1. Berry SA, Fleishman JA, Moore RD, Gebo KA. Trends in reasons for hospitalization in a multisite United States cohort of persons living with HIV, 2001–2008. J Acquir Immune Defic Syndr 2012; 59:368–75. - PMC - PubMed
    1. Fleming J, Berry SA, Moore RD, et al. U.S. hospitalization rates and reasons stratified by age among persons with HIV 2014–15. AIDS Care 2019; 32:1353–62. - PubMed
    1. Davy-Mendez T, Napravnik S, Hogan BC, et al. Hospitalization rates and causes among persons with HIV in the US and Canada, 2005–2015 [manuscript published online ahead of print 21 October 2020]. J Infect Dis 2020. doi: 10.1093/infdis/jiaa661. - DOI
    1. Healthcare Cost and Utilization Project. HCUP fast stats.https://www.hcup-us.ahrq.gov/faststats/NationalTrendsServlet. Accessed 12 August 2019.
    1. Canadian Institute for Health Information. Inpatient hospitalizations: volumes, length of stay and standardized rates.https://apps.cihi.ca/mstrapp/asp/Main.aspx. Accessed 8 April 2020.

Publication types

Substances

Grants and funding