Current and Past Immunodeficiency Are Associated With Higher Hospitalization Rates Among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years
Authors: Davy-Mendez Thibaut , Napravnik Sonia , Eron Joseph J , Cole Stephen R , van Duin David , Wohl David A , Hogan Brenna C , Althoff Keri N , Gebo Kelly A , Moore Richard D , Silverberg Michael J , Horberg Michael A , Gill M John , Mathews W Christopher , Klein Marina B , Colasanti Jonathan A , Sterling Timothy R , Mayor Angel M , Rebeiro Peter F , Buchacz Kate , Li Jun , Nanditha Ni Gusti Ayu , Thorne Jennifer E , Nijhawan Ank , Berry Stephen A ,   North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiology Databases to Evaluate AIDS (IeDEA), Benson Constance A , Bosch Ronald J , Kirk Gregory D , Mayer Kenneth H , Grasso Chris , Hogg Robert S , Montaner Julio S G , Salters Kate , Lima Viviane D , Sereda Paul , Trigg Jason , Buchacz Kate , Li Jun , Gebo Kelly A , Moore Richard D , Moore Richard D , 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 oanne , Hunter-Mellado Robert F , Mayor Angel M , Gill M John , 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: December 2020

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 &lt;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 &lt;200 cells/μL (44%), patients with current CD4 count 200–350 vs &gt;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 &gt;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.