Hospitalization In HIV-infected Patients Research Articles

Erratum: Impact of comorbidity on the risk and cost of hospitalization in HIV-infected patients: real-world data from Abruzzo Region [Corrigendum

[This corrects the article on p. 389 in vol. 10, PMID: 30087571.].

Impact of comorbidity on the risk and cost of hospitalization in HIV-infected patients: real-world data from Abruzzo Region.

BackgroundDue to the success of antiretroviral therapy, human immunodeficiency virus (HIV) infection has been transformed into a lifelong condition. In Italy, little is known about the impact of comorbidities (CMs) on the risk of hospitalization and related costs for people who live with HIV (PWLHIV). The objective of the study was to quantify the risk of hospitalization and costs associated with CMs in an Italian cohort of PWLHIV.MethodsThe study population included subjects aged ≥18 years with HIV infection, identified in the Abruzzo’s hospital discharge database among files stored from 2004 until 2013 and then followed up until December 2015. Patients’ CMs (Charlson Comorbidity Index [CCI)] were extracted from International Classification of Diseases, Ninth Revision, Clinical Modification codes in the hospital discharge abstracts. Poisson regression was used to compare the incidence rate of hospital admissions in patients with and without each CM class. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were adjusted for age, sex and the other CMs. A generalized linear model under gamma distribution was used to estimate adjusted mean hospital costs. Costs were derived from official Italian Diagnosis-related group (DRG) based reimbursements.ResultsAmong 1,026 HIV patients identified (mean age 47 years), 30% had at least one CM and 14.5% underwent hospital admission during the follow-up period. The risk of acute hospitalization significantly increased among patients with hepatitis C virus (HCV) coinfection (adjusted IRR 1.98; 95% CI: 1.59–2.47), renal (adjusted IRR 2.27; 95% CI: 1.45–3.56), liver (adjusted IRR 2.21; 1.57–3.13) and chronic pulmonary CMs (adjusted IRR 2.31; 1.63–3.32). Adjusted mean hospital costs were €2,494 in patients without CMs and €4,422 and €9,734 in those with CCI=1 or CCI ≥2, respectively.ConclusionThe presence of renal, liver and chronic pulmonary CMs, as well as HCV coinfection doubled the risk of hospitalization in the PWLHIV cohort. A CCI ≥2 is associated with a fourfold increase in hospitalization costs. Our study provides new evidence that CMs in PWLHIV increase the risk of hospitalization and local health service facilities.

Impact of Comorbidities on The Risk And Cost of Hospitalization In Hiv-Infected Patients: Real World Data From The Abruzzo Region

Impact of Comorbidities on The Risk And Cost of Hospitalization In Hiv-Infected Patients: Real World Data From The Abruzzo Region

Plasma n-6 Fatty Acid Levels Are Associated With CD4 Cell Counts, Hospitalization, and Mortality in HIV-Infected Patients.

Fatty acids, including n-6 series, modulate immune function, but their effect on CD4 cell counts, death, or hospitalization in HIV-infected patients on antiretroviral therapy is unknown. In a randomized trial for effects of multivitamins in HIV-infected patients in Uganda, we used gas chromatography to measure plasma n-6 fatty acids at baseline; determined CD4 counts at baseline, 3, 6, 12, and 18 months; and recorded hospitalization or death events. The associations of fatty acids with CD4 counts and events were analyzed using repeated-measures analysis of variance and Cox regression, respectively. Among 297 patients with fatty acids measurements, 16 patients died and 69 were hospitalized within 18 months. Except for linoleic acid, n-6 fatty acids levels were positively associated with CD4 counts at baseline but not during follow-up. In models that included all 5 major n-6 fatty acids, age; sex; body mass index; anemia status; use of antiretroviral therapy, multivitamin supplements, and alcohol; and the risk of death or hospitalization decreased significantly with an increase in linoleic acid and gamma-linolenic acid levels, whereas associations for dihomo-gamma-linolenic acid, arachidonic acid, and aolrenic acid were null. The hazard ratios (95% confidence intervals) per 1 SD increase in linoleic acid and gamma-linolenic acid were 0.73 (0.56-0.94) and 0.51 (0.36-0.72), respectively. Gamma-linolenic acid remained significant (hazard ratio = 0.51; 95% confidence interval: 0.35 to 0.68) after further adjustment for other plasma fatty acids. Lower levels of gamma-linolenic acid are associated with lower CD4 counts and an increased risk of death or hospitalization. These results suggest a potential for using n-6 fatty acids to improve outcomes from antiretroviral therapy.

Comparing total health care costs and treatment patterns of HIV patients in a managed care setting

The objective of this study was to investigate total health care costs and time to occurrence of hospitalization in HIV-infected patients treated according to the 1998 DHHS guidelines in a managed care setting. The study also investigated which patients do not receive guideline treatment. We used a retrospective cross-sectional study design using medical and pharmacy claims data. Data from 1,791 HIV-infected patients using antiretroviral agents between 1 February 1998 and 31 July 1999, including demographic characteristics, medication guideline use, medication adherence and cost of care, were examined. Factors associated with total health care costs and time-to-inpatient admission (as a proxy for patient outcomes) were assessed. Patients receiving guideline (HAART) therapy (55%) had higher prescription and total health care costs but lower medical costs. Patients not receiving treatment according to guidelines were more likely to be female, older, have comorbidities, lower medication adherence and no AIDs-defining illness. Treatment with HAART guidelines was associated with longer time-to-inpatient admission controlling for other factors. In a short-term cross-sectional analysis, patients treated with HAART guidelines had better outcomes based on time-to-inpatient admission but higher prescription and total health care costs. Some patients are at risk for not receiving care according to national treatment guidelines and may be targeted for intervention programmes.

Motivo de ingreso en pacientes infectados por el virus de la inmunodeficiencia humana en un área rural. Papel de la hepatopatía crónica

To investigate whether the use of highly active retroviral therapy (HAART) has resulted in changes in the causes of hospitalization in human immunodeficiency virus (HIV)-infected patients and to assess the influence of hepatitis C virus (HCV) infection in this population. The causes of hospitalization in HIV-infected patients in our center were retrospectively studied according to two time periods: 1 January 1994 to 31 December 1997 (group 1, no patients treated with HAART) and 1 January 1998 to 30 June 2001 (group 2, 63% of patients treated with HAART). Epidemiological, virological and immunological parameters, and HCV infection data were studied. As compared to patients in group 1, patients admitted to the hospital in group 2 were older (34.7 +/- 6.3 versus 30.6 +/- 4.6 years, P = 0.0037), had a higher CD4+ lymphocyte count (256 +/- 243 versus 146 (178, P = 0.044) and their hospital stays were significantly lower (7.7 +/- 6.3 versus 17.5 +/- 16.7, P = 0.003). Moreover, the percentage of hospitalizations for AIDS-defining diseases was lower (29% versus 50%, P = 0.046) and the percentage of hospitalizations for decompensated liver disease was higher (22% versus 0%, P = 0.007) in group 2. Among patients who died during hospitalization, there was a higher frequency of low CD4+ lymphocyte counts (77.8% versus 43.3%, P = 0.05), active HCV infection (100% versus 57.9%, P = 0.02) and AIDS-defining disease or decompensated liver disease as the cause of hospitalization (81.8% versus 45%, P = 0.02) than among survivors. Low CD4+ lymphocyte count was independently associated with mortality (OR 1063.1; 95% CI 1.3-838855.5). Since the introduction of HAART in our setting, the frequency of opportunistic infections has decreased and the frequency of decompensated liver disease has increased among the causes of hospitalization in HIV-infected patients.

Hospitalized HIV-infected patients in the HAART era: a view from the inner city.

To evaluate hospitalizations of HIV-infected patients in the highly active antiretroviral therapy (HAART) era, we analyzed 2736 admissions of 1562 HIV-infected patients to Cook County Hospital from September 20, 1999 to July 10, 2002. Patients were predominantly African American (81%), male (72%), and active substance abusers (74%). Only 48% of patients with a prior HIV diagnosis were taking HAART and 37% of them had a viral load less than 1000 copies per milliliter. Patients on protease inhibitor (PI)-sparing regimens more frequently achieved a viral load less than 1000 copies per milliliter than those on a PI-containing regimens (41% vs. 34% p = 0.036). For patients with CD4 cell counts less than 200 cells per milliliter, those not taking HAART were more likely African American (83% vs. 76%, p < 0.031), homeless (13% vs. 5%, p < 0.001), active substance abusers (79% vs. 65%, p < 0.001), female (28% vs. 22%, p = 0.001), new to the hospital system (19% vs. 6%, p < 0.001), or not recently seen in the outpatient clinic (42% vs. 17%, p < 0.001). In our population, active substance abuse was prevalent and only a minority of patients was taking HAART. Women were receiving HAART less often, independent of race and substance abuse. Aggressive programs are needed in high-risk populations to address substance abuse issues and to improve patient use of HAART.

Characteristics of Hospitalizations of HIV-Infected Patients: An Analysis of Data From the 1994 Healthcare Cost and Utilization Project

Characteristics of Hospitalizations of HIV-Infected Patients: An Analysis of Data From the 1994 Healthcare Cost and Utilization Project