National trends in hospitalization and mortality rates for patients with HIV, HCV, or HIV/HCV coinfection from 1996-2010 in the United States: a cross-sectional study.

Christine U Oramasionwu,Joshua C Toliver,Terence L Johnson,Christopher R Frei,Heather N Moore

doi:10.1186/1471-2334-14-536

Abstract

BackgroundThe comparative impact of chronic viral monoinfection versus coinfection on inpatient outcomes and health care utilization is relatively unknown. This study examined trends, inpatient utilization, and hospital outcomes for patients with HIV, HCV, or HIV/HCV coinfection.MethodsData were from the 1996–2010 National Hospital Discharge Surveys. Hospitalizations with primary ICD-9-CM codes for HIV or HCV were included for HIV and HCV monoinfection, respectfully. Coinfection included both HIV and HCV codes. Demographic characteristics, select comorbidities, procedural interventions, average hospital length of stay (LOS), and discharge status were compared by infection status (HIV, HCV, HIV/HCV). Annual disease estimates and survey weights were used to generate hospitalization rates.Results~6.6 million hospitalizations occurred in patients with HIV (39%), HCV (56%), or HIV/HCV (5%). The hospitalization rate (hospitalizations per 100 persons with infection) decreased in the HIV group (29.8 in 1996; 5.3 in 2010), decreased in the HIV/HCV group (2.0 in 1996; 1.5 in 2010), yet increased in the HCV group (0.2 in 1996; 0.9 in 2010). Median LOS from 1996 to 2010 (days, interquartile range) decreased in all groups: HIV, 6 (3–10) to 4 (3–8); HCV, 5 (3–9) to 4 (2–6); HIV/HCV, 6 (4–11) to 4 (2–7). Age-adjusted mortality rates decreased for all three groups. The rate of decline was least pronounced for those with HCV monoinfection.ConclusionHospitalizations have declined more rapidly for patients with HIV infection (including HIV/HCV coinfection) than for patients with HCV infection. This growing disparity between HIV and HCV underscores the need to allocate more resources to HCV care in hopes that similar large-scale improvements can also be accomplished for patients with HCV.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-536) contains supplementary material, which is available to authorized users.

Highlights

The comparative impact of chronic viral monoinfection versus coinfection on inpatient outcomes and health care utilization is relatively unknown
Comorbidities were distributed across the three groups (HIV, hepatitis C virus (HCV), Human Immunodeficiency Virus (HIV)/HCV) as follows: hepatitis B (2%, 5%, 10%), illicit drug use (15%, 17%, 24%), and alcohol use (9%, 19%, 13%)
Inpatient procedures were distributed across the three groups (HIV, HCV, HIV/HCV) as follows: transfusion (8%, 9%, 8%), central line placement (8%, 8%, 8%), lumbar puncture (7%, 1%, 5%), bronchoscopy (5%, 1%, 3%), and upper GI endoscopy (4%, 6%, 4%)

Summary

Introduction

The comparative impact of chronic viral monoinfection versus coinfection on inpatient outcomes and health care utilization is relatively unknown. This study examined trends, inpatient utilization, and hospital outcomes for patients with HIV, HCV, or HIV/HCV coinfection. Combination HIV antiretroviral therapy and combination HCV antiviral therapy have been recommended since the 1990s, as the respective Since these combination therapies became available, few studies have documented how health care utilization patterns differ for patients with coinfection versus monoinfection. The burden that patients with coinfection place on the U.S inpatient health care delivery system, as compared to patients with monoinfection, is relatively unknown. This study chronicled and compared inpatient health care utilization, including hospitalization rates, median length of hospital stay (LOS), and patient mortality rates, for patients with HIV, HCV, or HIV/HCV coinfection

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