HIV patients in care are hospitalized substantially less often than in the past

Among patients with HIV who are in care, the rate of hospitalization for any cause declined substantially during a recent 10-year period, according to study findings published in The Journal of Infectious Diseases.

Hospitalization rates declined despite the potential effects of aging, comorbidities and cumulative exposure to HIV and antiretrovirals, researchers said.

Thibaut Davy-Mendez

In their study, Thibaut Davy-Mendez, PhD, a post-doctoral fellow in the department of psychiatry and behavioral sciences at the University of California, San Francisco, Stephen A. Berry, MD, PhD, associate professor of medicine at Johns Hopkins University School of Medicine, and colleagues examined trends in all-cause and cause-specific hospitalization rates between 2005 and 2015 to assess the possible impact of ART improvements, aging and comorbidities on hospitalizations among people living with HIV (PLWH) who are receiving care.

The study included PLWH receiving care in six clinical cohorts in the United States and Canada.

Among the 28,057 patients ultimately included in the study, the median CD4 increased from 389 to 580 cells/µL, and the proportion of patients who were virologically suppressed rose from 55% to 85%.

According to the researchers, the unadjusted all-cause hospitalization rate decreased from 22.3 per 100 person years in 2005 (95% CI, 20.6-24.1) to 13 per 100 person years in 2015 (95% CI, 12.2-14). Additionally, unadjusted rates decreased for almost all diagnostic categories, whereas adjusted rates decreased for all-cause, cardiovascular and AIDS-defining conditions. They increased for non-AIDS-defining infection and were stable for most other categories.

According to Davy-Mendez and Berry, previous data showed similar results. Data from the 2000s revealed a decrease in hospitalization rates among PLWH but slight increases in cardiovascular and kidney disease hospitalizations. Additionally, more recent studies in North Carolina and Italy found a continued decrease in hospitalization rates among people with HIV through 2016.

“Our study is the most recent work reporting hospitalization trends across a large number of people living with HIV in the United States and Canada,” they said. “Based on previous studies, we expected that non-AIDS-defining infections would make up a substantial percentage of hospitalization reasons. However, we did not expect to see a small increase in the adjusted hospitalization rate [of] non-AIDS-defining infections.”

They said this finding will require further investigation to understand the drivers of these infections and possible ways to prevent them.