Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005–2015
Authors: Davy-Mendez Thibaut , Napravnik Sonia , Hogan Brenna C , Althoff Keri N , Gebo Kelly A , Moore Richard D , Horberg Michael A , Silverberg Michael J , Gill M John , Crane Heidi M , Marconi Vincent C , Bosch Ronald J , Colasanti Jonathan A , Sterling Timothy R , Mathews W Christopher , Mayor Angel M , Nanditha Ni Gusti Ayu , Buchacz Kate , Li Jun , Rebeiro Peter F , Thorne Jennifer E , Nijhawan Ank , van Duin David , Wohl David A , Eron Joseph J , Berry Stephen A ,   North American AIDS Cohort Collaboration on Research and Design of IeDEA, Benson Constance A , Bosch Ronald J , Kirk Gregory D , Mayer Kenneth H , Grasso Chris , Hogg Robert S , Harrigan P Richard , Montaner Julio S G , Yip Benita , Zhu Julia , Salters Kate , Gabler Karyn , Buchacz Kate , Li Jun , Gebo Kelly A , Moore Richard D , Moore Richard D , Carey John T , Rodriguez Benigno , Horberg Michael A , Silverberg Michael J , Thorne Jennifer E , Brown Todd , Tien Phyllis , D’Souza Gypsyamber , Rabkin Charles , Klein Marina B , Kroch Abigail , Burchell Ann , Betts Adrian , Lindsay Joanne , Hunter-Mellado Robert F , Mayor Angel M , John Gill M , Martin Jeffrey N , Li Jun , Brooks John T , Saag Michael S , Mugavero Michael J , Willig James , Mathews William C , Eron Joseph J , Napravnik Sonia , Kitahata Mari M , Crane Heidi M , Sterling Timothy R , Haas David , Rebeiro Peter , Turner Megan , Tate Janet , Dubrow Robert , Fiellin David , Moore Richard D , Althoff Keri N , Gange Stephen J , Kitahata Mari M , Saag Michael S , Horberg Michael A , Klein Marina B , McKaig Rosemary G , Freeman Aimee M , Moore Richard D , Althoff Keri N , Freeman Aimee M , Kitahata Mari M , Van Rompaey Stephen E , Crane Heidi M , Morton Liz , McReynolds Justin , Lober William B , Gange Stephen J , Althoff Keri N , Lee Jennifer S , You Bin , Hogan Brenna , Zhang Jinbing , Jing Jerry , Humes Elizabeth , Gerace Lucas , Coburn Sally 
Published: October 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.