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Impact of Hepatitis Coinfection on Hospitalization Rates and Causes in a Multicenter Cohort of Persons Living With HIV

Crowell, Trevor A. MD*; Gebo, Kelly A. MD, MPH*; Balagopal, Ashwin MD*; Fleishman, John A. PhD; Agwu, Allison L. MD, ScM*,†; Berry, Stephen A. MD, PhD*for the HIV Research Network

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1st, 2014 - Volume 65 - Issue 4 - p 429–437
doi: 10.1097/QAI.0000000000000059
Clinical Science

Background: Chronic viral hepatitis is a potentially important determinant of health care utilization among persons living with HIV. We describe hospitalization rates and reasons for hospitalization among persons living with HIV stratified by coinfection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV).

Methods: Laboratory, demographic, and hospitalization data were obtained for all patients receiving longitudinal HIV care during 2010 at 9 geographically diverse sites. Hepatitis serostatus was assessed by hepatitis B surface antigen and/or hepatitis C antibody. ICD-9 codes were used to assign hospitalizations into diagnostic categories. Negative binomial regression was used to assess factors associated with all-cause and diagnostic category-specific hospitalizations.

Results: A total of 2793 hospitalizations were observed among 12,819 patients. Of these patients, 49.3% had HIV monoinfection, 4.1% HIV/HBV, 15.4% HIV/HCV, 2.5% HIV/HBV/HCV, and 28.7% unknown hepatitis serostatus. Compared with HIV monoinfection, the risk of all-cause hospitalization was increased with HIV/HBV [adjusted incidence rate ratio 1.55 (1.17 to 2.06)], HIV/HCV [1.45 (1.21 to 1.74)], and HIV/HBV/HCV [1.52 (1.04 to 2.22)]. Risk of hospitalization for non–AIDS-defining infection was also higher among patients with HIV/HBV [2.07 (1.38 to 3.11)], HIV/HCV [1.81 (1.36 to 2.40)], and HIV/HBV/HCV [1.96 (1.11 to 3.46)]. HIV/HBV was associated with hospitalization for gastrointestinal/liver disease [2.55 (1.30 to 5.01)]. HIV/HCV was associated with hospitalization for psychiatric illness [1.89 (1.11 to 3.26)].

Conclusions: HBV and HCV coinfection are associated with increased risk of all-cause hospitalization and hospitalization for non–AIDS-defining infections, as compared with HIV monoinfection. Policy-makers and third-party payers should be aware of the heightened risk of hospitalization associated with coinfection when allocating health care resources and considering models of health care delivery.

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Departments of *Medicine and

Pediatrics Johns Hopkins University, Baltimore, MD; and

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

Correspondence to: Trevor A. Crowell, MD, Division of Infectious Diseases and HIV Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 457, Baltimore, MD 21287 (e-mail:

Presented, in part, at the 20th Conference on Retroviruses and Opportunistic Infections, March 3–6, 2013, Atlanta, GA.

Supported by the Agency for Healthcare Research and Quality (HHSA290201100007C), the Health Resources and Services Administration (HHHSH250201200008C), the National Institute of Allergy and Infectious Diseases (K23 AI084854), and the National Institute on Drug Abuse (R01 DA016078).

The authors have no conflicts of interest to disclose.

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

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 (

Received September 25, 2013

Accepted November 02, 2013

© 2014 by Lippincott Williams & Wilkins