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Aging, Hospitalization Rates for Liver/GI -
Rates Increased for Cardiovascular Disease & Non-AIDS Cancers in Italy
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from Jules:
the authors said in their conclusions: "Considering age, hospitalization for liver/gastrointestinal diseases and cardiovascular diseases were more frequent among patients older than 50 years."
Although there is no comparison group of HIV-uninfected, overall hospitalizations rates due to non-AIDS infections are worrisome, so are liver/GI rates for hospitalizations (although these came down a little that could be due to successful HCV treatment and HCV+ individuals dying due to end-stage liver disease); and then of course there is the apparently high increase in the cardiovascular-related rate for hospitalization & the very high increase in Non-AIDS cancer rate for hospitalization. Just a peak at the FUTURE OF AGING with HIV !!!!
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Hospital Admission Rate Plummets in Italian HIV Cohort, But Rises for Cancer
IAS 2015, July 19-22, 2015, Vancouver
Mark Mascolini
From 1997 through 2012, hospital admissions of HIV-positive Icona cohort members dropped to a level approaching that of the general population [1]. Admission rates for all causes analyzed fell, except for non-AIDS cancer (admissions rose) and cardiovascular disease (admissions stayed flat).
Hospital admissions slumped dramatically after the arrival of combination antiretroviral therapy (cART). Because less is known about recent admission trends, Icona cohort investigators analyzed records of 10,527 HIV-positive people in four periods: 1997-1999, 2000-2005, 2006-2009, and 2010-2012.
Of the 10,527 people studied, 25% were women, 38% heterosexual, 31% men who have sex with men (MSM), and 23% injection drug users (IDUs). Median age stood at 36 years, and 27% of the cohort had HCV infection. During follow-up 1760 people (17%) went to the hospital in 3094 separate admissions. AIDS-defining infections accounted for the highest proportion of admissions (37%), followed by non-AIDS infections (19%), liver/gastrointestinal (GI) disease (11%), non-AIDS cancer (6%), and cardiovascular disease (4%).
The overall admission rate plunged from 17 per 100 person-years in 1997 to 4 per 100 person-years in 2012 (P < 0.001). Admissions for AIDS infections, non-AIDS infections, and liver/GI disease all fell significantly (P < 0.001 for all). Admissions for cardiovascular disease stayed flat and below 1 per 100 person-years throughout the study period. Admissions for non-AIDS cancers rose significantly, approaching 1 per 100 person-years in 2010-2012 (P < 0.001). Over time, admissions for liver/GI disease and cardiovascular disease proved more frequent in people older than 50.
A multivariable Poisson model identified several independent predictors of higher or lower risk of hospital admission, at the following relative rates (RR) (and 95% confidence intervals):
Higher risk of admission
Age 50 or older vs 18 to 35: RR 1.28 (1.13 to 1.45)
Late presentation to care: RR 1.13 (1.03 to 1.24)
Recent gap in care: RR 2.19 (1.54 to 3.11)
Lower risk of admission
Male vs female: RR 0.78 (0.72 to 0.86)
MSM transmission vs IDU: RR 0.60 (0.52 to 0.68)
Heterosexual transmission vs IDU: RR 0.52 (0.47 to 0.59)
Current CD4 count 200-349 vs under 200: RR 0.36 (0.32 to 0.40)
Current CD4 count 350 to 499 vs under 200: RR 0.21 (0.19 to 0.24)
Current CD4 count 500 or higher vs under 200: RR 0.14 (0.12 to 0.15)
cART period 2000-2005 vs 1997-1999: RR 0.79 (0.71 to 0.88)
cART period 2006-2009 vs 1997-1999: RR 0.75 (0.67 to 0.85)
cART period 2010-2012 vs 1997-1999: RR 0.73 (0.64 to 0.82)
The researchers stressed that AIDS and non-AIDS infections still account for half of hospital admissions in this cohort. They noted that all cohort members are in care, so results may not apply to HIV-positive people not in care.
Reference
1. Mammone A, Cauda R, Vullo V, et al. Trend and causes of hospitalizations among patients with HIV entering care in Italy: a 15 years study from the ICONA cohort. IAS 2015. 8th Conference on HIV Pathogenesis, Treatment and Prevention. July 19-22, 2015. Vancouver. Abstract MOPEB155.
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Reported by Jules Levin
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