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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0000000000000126
HIV Reports

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

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Abstract

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.

Copyright © 2014 by Lippincott Williams & Wilkins

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