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Higher Hospital Rate With HIV in Women and Straight Men Than in MSM
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HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow
Mark Mascolini
Men who have sex with women (MSW) and women got admitted to the hospital after HIV diagnosis more often than men who have sex with men (MSM), according to a 10-year analysis at London's Royal Free Hospital [1]. Black race had a different impact on admission risk in MSW and women.
People with HIV still get admitted to the hospital more than the general population, noted University College London and Royal Free researchers who conducted this study. But little research has assessed the impact of gender and sexual orientation on hospital admission among people with HIV. To address those issues, they analyzed all-cause hospitalization of HIV-positive people in the Royal Free HIV Cohort Study from January 2007 to January 2017. They performed two separate analyses, one examining admissions in the first year after HIV diagnosis and one assessing admissions more than 1 year after HIV diagnosis.
The first analysis involved 655 MSM, 307 MSW, and 345 women with median ages of 36, 42, and 37 and median CD4 counts at HIV diagnosis of 446, 255, and 255. MSM included a higher proportion of whites and lower proportion of blacks (78% and 7%) than did MSW (39% and 45%) or women (18% and 71%). Proportions who started antiretroviral therapy (ART) within 3 months of diagnosis were 52% for MSM, 72% for MSW, and 72% for women.
Overall in the first year after HIV diagnosis the researchers counted 166 hospital admissions among 1307 people for a rate of 15.3 per 100 person-years. Non-AIDS causes explained 69% of admissions among MSM, 54% among MSW, and 60% among women. The admission rate was substantially lower for MSM (about 6 per 100 person-years) than for black MSW (about 27 per 100), other MSW (about 31 per 100), black women (about 25 per 100), or other women (about 20 per 100). Multivariable analysis adjusted for age at HIV diagnosis, year of diagnosis, and initial CD4 count determined that MSW and women had 2- to 3-fold higher risks of hospital admission than MSM, at the following adjusted hazard ratios (aHR) (and 95% confidence intervals):
Compared with MSM:
-- Black MSW: aHR 2.4 (1.5 to 4.0)
-- Other MSW: aHR 3.2 (2.0 to 5.1)
-- Black women: aHR 2.4 (1.6 to 3.8)
-- Other women: aHR 2.3 (1.3 to 4.2)
The analysis of admissions more than 1 year after HIV diagnosis involved 2310 MSM, 822 MSW, and 1079 women with median ages of 41, 43, and 39 and median initial CD4 counts of 520, 400, and 437. MSM included a higher proportion of whites and lower proportion of blacks (83% and 5%) than did MSW (38% and 48%) and women (19% and 70%), and MSM had been infected with HIV longer than MSW and women (median 6 versus 4 versus 4 years).
More than 1 year after HIV diagnosis there were 773 hospital admissions of 553 people (median 1, range 1 to 8) for a rate of 2.9 per 100 person-years. Non-AIDS causes explained large majorities of admissions in MSM (94%), MSW (86%), and women (91%). The admission rate was again substantially lower in MSM (about 2 per 100 person-years) than in black MSW (about 3.8 per 100), other MSW (about 4.9 per 100), black women (about 3.8 per 100) and other women (about 3.2 per 100).
Statistical analysis comparing hospital admission rate in MSW and women versus MSM adjusted for current age, current CD4 count, CD4 nadir, current viral suppression, years since diagnosis, and previous AIDS. This analysis determined that nonblack MSW and black women (but not black MSW or other women) had a significantly higher risk of hospital admission than MSM, at the following adjusted hazard ratio (aHR) (and 95% confidence intervals):
Compared with MSM:
-- Black MSW: aHR 1.1 (0.8 to 1.5, not significant)
-- Other MSW: aHR 1.8 (1.3 to 2.4)
-- Black women: aHR 1.4 (1.1 to 1.8)
-- Other women: aHR 1.4 (0.9 to 2.1, not significant)
The researchers underlined the finding that black race may affect hospital admission differently in MSW and in women. They suggested that reasons for the observed admission differences could include (1) social determinants, (2) structural barriers and engagement in care, (3) differences in risk of exposure to other pathogens, and (4) biological differences. They are currently assessing the impact of socioeconomic status on hospital admission and ICD-10 code reasons for admission.
Reference
1. Rein S, Lampe FC, Johnson MA, et al. Risk of hospitalisation according to gender, sexuality and ethnicity among people with HIV in the modern ART era. HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow. Abstract O114.
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