Hospitalization of People with HIV Has Decreased by More than Half since 1994

By Liz Highleyman

The introduction of effective combination antiretroviral therapy in the mid-1990s dramatically reduced morbidity and mortality among people with HIV, and long-term studies continue to quantify these benefits over time.

As reported in the July 11, 2008, issue of AIDS, Kate Buchacz of the Centers for Disease Control and Prevention (CDC) and colleagues conducted a prospective cohort study to assess temporal trends in rates of hospitalization and associated diagnoses before and during the HAART era.

The investigators analyzed medical records from 7155 participants in the HIV Outpatient Study (HOPS) cohort, which includes patients at 10 U.S. clinics. They evaluated rates of hospitalization for major categories of medical conditions from 1994 through 2005, and modeled trends using multivariable Poisson regression models.

Results

• The overall rate of hospitalizations among people with HIV fell by more than half between 1994 and 2005.

• The hospitalization rate fell from 24.6 per 100 person-years in 1994 to 11.8 per 100 person-years in 2005 (P < 0.0001).

• Declines were similar for men and women, and for all racial/ethnic groups.

• The rate of hospitalizations for AIDS-related opportunistic infections decreased from 7.6 per 100 person-years in 1994-1996 to 1.0 per 100 person-years in 2003-2005 (P < 0.0001).

• 31% of hospitalizations in 1994-1996 involved opportunistic infections, falling to 9.5% in 2003-2005.

• By contrast, 7.2% of hospitalizations in 1994-1996 involved chronic end-organ disease conditions, rising to 14.3% in 2003-2005.

• The mean CD4 cell count at the time hospitalization increased from 115 cells/mm3 in 1994 to 310 cells/mm3 in 2005, indicating less severe immune compromise.

• Factors independently associated with hospitalization in the HAART era (1997-2005) included:

- Older patient age;
- History of substance abuse;
- Lower CD4 cell count;
- History of an AIDS diagnosis or AIDS-defining conditions;
- Use of public health insurance (e.g., Medicaid).

"The rates of hospitalizations for HIV-infected patients declined substantially during 1994-2005, due mainly to reductions in the AIDS opportunistic infections," the study authors concluded. "Compared with the period 1994-1997, patients in the highly active antiretroviral therapy era were hospitalized with higher CD4+ cell counts and more frequently for chronic end-organ conditions."

These findings confirm the experience of countless HIV positive patients and their providers, who have largely shifted their attention to managing the risk of cardiovascular disease, metabolic syndrome, and other chronic conditions.

7/04/08

Reference
K Buchacz, RK Baker, AC Moorman, and others (HIV Outpatient Study (HOPS) Investigators). Rates of hospitalizations and associated diagnoses in a large multisite cohort of HIV patients in the United States, 1994-2005. AIDS 22(11): 1345-1354. July 11, 2008.

Abstract