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Aging HIV+ Hospitalized More Often: Non-AIDS Infections, Heart and GI Disease Explain Most Hospitalizations in Over-50 People With HIV
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First International Workshop on HIV and Aging, October 4-5, 2010, Baltimore
Mark Mascolini
Compared with HIV-infected people under 50 years old, those 50 and older got admitted to the hospital significantly more often for all causes, cardiovascular disease, and gastrointestinal or liver conditions [1]. AIDS illnesses accounted for only 3% of hospital admissions in the 50-and-older group, a rate lower than in people under 50.
Researchers at Johns Hopkins University analyzed hospitalization rates in 19 mutually exclusive diagnostic categories for HIV-infected people seen at clinics in San Diego, Portland, New York City, and Baltimore from 2001 through 2008. The analysis focused on 11,546 people in care for a median of 3 years. In 2008 there the 50-and-older group included 1695 people, and the under-50 group included 3489. Median ages of the two groups in 2008 were 54 and 42, 27% in each group were women, and nearly two thirds in each group were nonwhite. In 2008 HIV transmission risk was more evenly divided in the older group (32% men who have sex with men [MSM], 30% injection drug users [IDUs], and 26% heterosexual) than in the younger group (42% MSM, 16% IDUs, and 27% heterosexual).
Median CD4 counts lay above 400 in both the older and younger groups in 2008. While approximately 70% in the older group had a viral load below 400 copies in 2008, about 60% in the younger group had a viral load under 400 copies.
All-cause hospitalization rate was 37% higher in the 50-and-older group (adjusted incidence rate ratio [IRR] 1.37, 95% confidence interval [CI] 1.27 to 1.49). Compared with men, women had a 23% higher hospital admission rate (95% CI 1.13 to 1.33), and compared with whites, blacks had a 40% higher rate (95% CI 1.29 to 1.52) and Hispanics had a 15% higher rate (1.04 to 1.29).
Rates of non-AIDS infection as a cause of admission did not differ substantially between older and younger people (between 8% and 9%). But the older group had a higher admission rate for cardiovascular disease (5% versus under 2%), GI and liver disease (3% versus about 2%), and renal disease, cancer, pulmonary disease, and endocrinologic disease (all approximately 2% versus 1%). In contrast, the younger group had a higher admission rate for AIDS-defining illnesses (over 5% versus 3% in older people).
Multivariate analysis determined that lower CD4 count, higher viral load, injection drug use, black race, and female gender all raised the risk of hospital admission for non-AIDS infections, but age 50 or older did not. Older age did independently raise the risk of admission for cardiovascular disease, nearly tripling the risk (IRR 2.74, 95% CI 2.24 to 3.34). Being 50 or older also independently boosted the risk of hospital admission for GI or liver disease (IRR 1.43, 95% CI 1.18 to 1.73).
The most frequent non-AIDS infection causes of admission were bacterial pneumonia, cellulitis, and sepsis. The most frequent cardiovascular causes were heart failure, coronary events, and chest pain. And the most frequent GI or liver causes were pancreatitis, GI bleeding, and cirrhosis. There was a trend toward lower risk of admission for AIDS illnesses in the older group (IRR 0.87, 95% CI 0.74 to 1.03).
The investigators urged HIV clinicians to focus on preventing non-AIDS infections by vaccinating people against pneumonia and flu. They proposed that the "relative frequency of cardiovascular hospitalizations validates ongoing research efforts on cardiovascular risk" in people with HIV.
Reference
1. Berry S, Moore R, Gebo K. Reasons for hospitalization differ among older and younger HIV-infected persons. First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_11.
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