Causes of hospitalisation among a cohort of people with HIV from a London centre followed from 2011 to 2018

Sophia M Rein,Colette J Smith,Sara Madge,Margaret A Johnson,Alison J Rodger,Fiona Burns,Alec Miners,Clinton Chaloner,Jeffrey Mcdonnell,Lorraine Sherr,Adam Stafford,Simon Collins,Fiona C Lampe,Andrew Speakman,Andrew N Phillips

doi:10.1186/s12879-021-06082-y

Abstract

BackgroundWe describe the spectrum of ICD-10 classified causes for hospitalisations occurring between 2011 and 2018 in a cohort of people living with HIV (PLHIV).MethodsThis sub-study includes 798 PLHIV participating in the Antiretroviral, Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study who were recruited from a large London centre. A medical record review identified the occurrence and causes of hospitalisation from the date of questionnaire completion (February–December 2011) until 1 June 2018. Up to five causes were classified by an HIV clinician using the ICD-10 system.ResultsThere were 274 hospitalisations in 153 people (rate = 5.8/100 person-years; 95% CI: 5.1, 6.5). Causes were wide-ranging; the most common were circulatory (16.8%), digestive (13.1%), respiratory (11.7%), infectious diseases (11.0%), injury/poisoning (10.6%), genitourinary diseases (9.9%) and neoplasms (9.1%). A tenth (27/274) of hospitalisations were related to at least one AIDS-defining illness. Median duration of hospitalisation was 5 days (IQR 2–9). At the time of hospitalisation, median CD4 count was high (510 cells/μl; IQR: 315–739), while median CD4 nadir was relatively low (113 cells/μl; IQR: 40–239). At admission, half of individuals (51%) had a previous AIDS-defining illness and 21% had viral load > 50 copies/ml. Individuals admitted for infectious diseases were particularly likely to have unfavourable HIV-related clinical characteristics (low CD4, viral non-suppression, not on antiretroviral therapy (ART), previous AIDS).ConclusionsIn the modern combination antiretroviral therapy era, the spectrum of causes of hospitalisation in PLHIV in the UK is wide-ranging, highlighting the importance of holistic care for PLHIV, including prevention, early detection and treatment of comorbidities.

Highlights

We describe the spectrum of ICD-10 classified causes for hospitalisations occurring between 2011 and 2018 in a cohort of people living with HIV (PLHIV)
Following the introduction of effective combination antiretroviral therapy (ART) in 1996, AIDS-related mortality and morbidity among people living with HIV (PLHIV)
Based on a detailed individual record review, we describe the spectrum of ICD-10 classified causes of hospitalisations, and patient and clinical characteristics at admission

Summary

Introduction

We describe the spectrum of ICD-10 classified causes for hospitalisations occurring between 2011 and 2018 in a cohort of people living with HIV (PLHIV). Monitoring the causes of hospitalisation among PLHIV in detail gives insight into changing patterns of. Few recent studies have comprehensively evaluated the causes of hospitalisation in PLHIV in the contemporary treatment era, and, to our knowledge, none from the UK. Based on a detailed individual record review, we describe the spectrum of ICD-10 classified causes of hospitalisations, and patient and clinical characteristics at admission. This descriptive analysis can improve our understanding of the current pattern of morbidity among PLHIV, and inform health care planning and interventions

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Results

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Conclusion