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Trends in Hospitalizations Among Children and Young Adults with Perinatally Acquired HIV

Berry, Stephen A. MD, PhD*; Gebo, Kelly A. MD, MPH*; Rutstein, Richard M. MD; Althoff, Keri N. PhD§; Korthuis, P. Todd MD, MPH; Gaur, Aditya H. MD; Spector, Stephen A. MD**; Warford, Robert CRNP††; Yehia, Baligh R. MD, MSHP‡‡; Agwu, Allison L. MD, ScM; for the HIV Research Network

Pediatric Infectious Disease Journal: May 2014 - Volume 33 - Issue 5 - p 488–494
doi: 10.1097/INF.0000000000000126
HIV Reports

Background: Contemporary trends in hospitalization patterns among perinatally HIV-infected (PHIV) patients are unknown. We describe rates and reasons for hospitalizations stratified by age group during 2003–2010 within a large cohort of PHIV patients.

Methods: 579 PHIV patients engaged in care at 6 geographically diverse pediatric HIV centers affiliated through the HIV Research Network were included. Modified Clinical Classification Software assigned primary ICD-9 codes into diagnostic categories. Analysis was performed using negative binomial regression with generalized estimating equations.

Results: There were 699 all-cause hospitalizations. The overall rate for the full cohort was 19.9/100 person-years, and overall rates for 0–4, 5–16 and 17–24 year-olds were 25.1, 14.7 and 34.2/100 person-years, respectively. Declines were seen in unadjusted all-cause rates for the whole group [incidence rate ratio per year, 0.93 (0.87–0.99)] and for 5–16 [0.87 (0.76–0.99)] and 17–24 year-olds [0.87 (0.80–0.95)]. After adjustment for CD4, HIV-1 RNA and demographics, rates were no longer declining. Non-AIDS-defining infections and AIDS-defining illnesses together caused 349 (50%) admissions. Declines in these categories drove the overall declines in unadjusted rates. No increases over time were seen for cardiovascular, renal or any other diagnostic categories.

Conclusions: While the declines in hospitalizations are reassuring, continued efforts are needed to address the persistently high infectious and non-infectious morbidity among PHIV patients. Innovative strategies may be most critical for 17–24 year-olds. Lack of increases in cardiovascular and renal admissions provides modest, preliminary reassurance against severe non-infectious complications from longstanding HIV infection and antiretroviral exposure.

From the Departments of *Medicine and Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA; §Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, Oregon Health and Science University, Portland, OR; Department of Pediatrics, St Jude’s Children’s Hospital, Memphis, TN; **Department of Pediatrics, University of California, San Diego, CA; ††Department of Medicine, St. Lukes-Roosevelt Hospital Center, New York, NY; and ‡‡Department of Medicine, University of Pennsylvania, Philadelphia, PA.

Accepted for publication October 2, 2013

This work was supported by AHRQ (HHSA290201100007C) and the Health Resources and Services Administration (HHSH250201200008C). S.A.B. is supported by the National Institutes of Health (NIH, K23 AI084854); K.A.G. has been a consultant and received research support from Tibotec, has been a consultant for Bristol Myers Squibb and has received payment for expert testimony to the US government; K.N.A. is supported by the NIH (K01 AI093197); B.R.Y. is supported by the NIH (K23 MH097647); P.T.K. is supported by the NIH (K23 DA019809); A.L.A. is supported by the NIH (K23 AI084549).

The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Stephen A. Berry, MD, PhD, Division of Infectious Diseases, Johns Hopkins School of Medicine, 1503 E. Jefferson St/Office 115/Baltimore, MD 21287. E-mail: sberry8@jhmi.edu.

© 2014 by Lippincott Williams & Wilkins, Inc.