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Trends in Reasons for Hospitalization in a Multisite United States Cohort of Persons Living With HIV, 2001–2008

Berry, Stephen A. MD, PhD*; Fleishman, John A. PhD; Moore, Richard D. MD, MHS*; Gebo, Kelly A. MD, MPH*For the HIV Research Network

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1st, 2012 - Volume 59 - Issue 4 - p 368–375
doi: 10.1097/QAI.0b013e318246b862
Clinical Science

Introduction: Hospitalization rates for comorbid conditions among persons living with HIV in the current highly active antiretroviral therapy era are unknown.

Methods: Hospitalization data from 2001 to 2008 were obtained on 11,645 adults receiving longitudinal HIV care at 4 geographically diverse US HIV clinics within the HIV Research Network. Modified clinical classification software from the Agency for Healthcare Research and Quality assigned primary ICD-9 codes into diagnostic categories. Analysis was performed with repeated measures negative binomial regression.

Results: During 2001 to 2008, the rate of AIDS-defining illness (ADI) hospitalizations declined from 6.7 to 2.7 per 100 person-years, incidence rate ratio per year, 0.89 (0.87, 0.91). Among the other diagnostic categories with average rates >2 per 100 person-years, cardiovascular hospitalizations increased over time [1.07 (1.03, 1.11)], whereas non–AIDS-defining infection [0.98 (0.96, 1.00)], psychiatric [0.96 (0.93, 1.00)], and gastrointestinal/liver [0.96 (0.92, 1.00)] were slightly decreasing or stable. Although less frequent overall, renal and pulmonary admissions also increased over time in univariate and multivariate analyses. Of all diagnostic categories, ADI admissions had the longest mean length of stay, 10.5 days.

Discussion: ADI hospitalizations have continued to decline in recent years but are still relatively frequent and potentially costly given long lengths of stay. Increases or stability in the rates of chronic end-organ disease admissions imply a need for broader medical knowledge among individual clinicians and/or teams who care for persons living with HIV and a need for long-term access to medications for these conditions.

*Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

Center for Financing, Access, and Cost Trends, Agency for Health Care Research and Quality, Rockville, MD.

Correspondence to: Stephen A. Berry, MD, PhD, Division of Infectious Diseases/1830 E. Monument St/Suite 452/Baltimore, MD 21287 (e-mail: sberry8@jhmi.edu).

The author R.D.M has been a consultant for Bristol-Myers Squibb and has received research funding from Merck, Pfizer, and Gilead. The author K.A.G. has been a consultant and received research funding from Tibotec.

Presented, in part, at the 18th International AIDS Conference, July 2010, Vienna, Austria; and at the first International Workshop on HIV and Aging, October 2010, Baltimore, MD.

The views expressed in this article are those of the authors. No official endorsement by the Department of Health and Human Services, the National Institutes of Health, or the Agency for Healthcare Research and Quality is intended or should be inferred.

The authors S.A.B and J.A.F. have no conflicts of interest to disclose.

Sponsorship: Agency for Healthcare Research and Quality (290-01-0012) and the National Institutes of Health K23AI084854, R01 AG026250, R01 DA011602, R01 AA16893, K24 DA00432.

HIVRN details are listed in Appendix I.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received July 15, 2011

Accepted December 14, 2011

© 2012 Lippincott Williams & Wilkins, Inc.