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AIDS illness, living in US South, lower CD4s linked to longer hospital stay with HIV
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Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2019, Seattle
Mark Mascolini
Having an AIDS illness, age over 60, living in the southern United States, or a sub-200 CD4 count predicted longer hospital stays in a study of 3196 people with HIV [1]. Race, sex, and HIV risk factor did not affect hospital length of stay.
A recent New York City study found one-third longer hospital stays with symptomatic HIV infection than in the general population [2]. But hospital length of stay fell over the years in that study and in a nationwide US analysis [3]. Because inpatient care accounts for about one third of US healthcare cost and because little is known about predictors of length of stay, US HIV Research Network investigators conducted this study.
The researchers focused on 3196 adults in active HIV care and admitted to the hospital in 2014-2015. The study group represented 14 sites, 6 in the East (36% of the study group), 4 in the South (43%), and 4 in the West (21%). Study participants had a median age of 50, two thirds were men, 51% black, 26% white, and 21% Hispanic. Two thirds of the study group had a viral load below 200 copies, and 56% had a CD4 count above 350.
Average length of stay proved longest with AIDS-defining illness (9.3 days), followed non-AIDS infections (7.4), pulmonary disease (7.3), psychiatric illness (7.0), cancer (7.0), and more distantly endocrine disorders, cardiovascular disease, kidney disease, and gastrointestinal disease. Overall length of stay averaged 6.8 days. AIDS-defining illness also accounted for the longest median hospital stay (6.5 days), followed by cancer (5.5), non-AIDS infections (5), endocrine disorders (5), and psychiatric illness (5).
In a multivariate negative binomial regression analysis, four variables independently predicted longer length of stay: AIDS-defining illness versus non-AIDS infections (adjusted incidence rate ratio [aIRR] 1.16, 95% confidence interval [CI] 1.02 to 1.32), Southern US versus Eastern US (aIRR 1.10, 95% CI 1.01 to 1.20), age 60 or older versus 18 to 29 (aIRR 1.17, 95% CI 1.02 to 1.34), and CD4 count below 200 versus above 350. No other diagnostic category independently predicted longer hospital stay. Neither did sex, race, or HIV risk factor. Compared with non-AIDS infections, five diagnostic categories predicted shorter hospital stays: endocrine disorders, hematologic disease, cardiovascular disease, gastrointestinal disease, and kidney disease.
The HIV Research Network team proposed that "efforts to improve ART initiation and adherence are critical to reducing length of stay, especially for AIDS-defining illness."
References
1. Fleming J, Berry S, Mathews WC, et al. Risk factors for increased hospital length of stay among PWH, 2014-2015. Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2019. Seattle. Abstract 899.
2. Rowell-Cunsolo TL, Liu J, Shen Y, Britton A, Larson E. The impact of HIV diagnosis on length of hospital stay in New York City, NY, USA. AIDS Care. 2018;30:591-595.
3. Berry SA, Fleishman JA, Moore RD, Gebo KA; HIV Research Network. Trends in reasons for hospitalization in a multisite United States cohort of persons living with HIV, 2001-2008. J Acquir Immune Defic Syndr. 2012;59:368-375.
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