1219. Alive and not well: Hospitalization rates highest for oldest perinatally HIV-infected youth 2001 2008
Session: Poster Abstract Session: Pediatric HIV
Saturday, October 22, 2011
Room: Poster Hall B1

Background: Perinatally HIV-infected (PHIV) youth (17-24 years old) may be at high risk for illness because of psychosocial (e.g. chronic nonadherence) and HIV-related (e.g. advanced immunosuppression, viral resistance) factors. We compared hospitalization rates among PHIV youth to rates among younger PHIV patients during 2001-2008.

Methods: Hospitalization data were obtained for PHIV patients aged 0-24 years receiving care at 4 geographically diverse (OR, TN, MD, PA) pediatric HIV clinics within the HIV Research Network. Clinical Classification Software from AHRQ was used to assign primary ICD-9 codes into diagnostic categories. Analysis was performed with repeated-measures negative binomial regression.

Results: Among 445 patients, 52% were female, 78% Black, and 4% Hispanic. Median follow-up was 8 years [IQR: 5-8]. Between 2001 and 2008, the percentage of PHIV youth increased from 1% to 29%, and the percentage with HIV RNA <400 copies/mL on the first yearly measurement increased from 30% to 68%.

On average during 2001-2008, PHIV youth were hospitalized more frequently (44.2 / 100PY) than patients aged 2-5 years (16.1 / 100PY) or 6-16 years (20.8 / 100PY), and, unlike for patients aged 6-16, hospitalizations for PHIV youth did not have a significantly declining linear trend over time (Figure). A model adjusted for gender, race, CD4, HIV RNA, and antiretroviral use estimated higher IRR's for PHIV youth compared to patients aged 2-5 or 6-16 in all years except 2001. Differences reached statistical significance in 2006 and 2007. Among PHIV youth, CD4 < 200 cells/microliter was the only independent predictor of a higher hospitalization rate, and the most frequent diagnostic categories for hospitalization were non-AIDS defining infections, AIDS defining illnesses, and psychiatric (17.4, 8.4, and 2.3 / 100PY, respectively).

Conclusion: PHIV youth are hospitalized at higher rates than younger PHIV children. In addition to morbidity, these hospitalizations may entail substantial cost. Interventions to improve the health of PHIV youth are urgently needed. Further studies which determine the relative impact of psychosocial versus HIV-related factors may help in designing such interventions.

PHIV_hosp_rates_by_age_groups_1.0.jpg


Subject Category: P. Pediatric and perinatal infections

Stephen Berry, MD PhD1, Kelly Gebo, MD, MPH1, Richard Rutstein, MD2, Keri Althoff, PhD MPH3, P. Todd Korthuis, MD, MPH4, Aditya Gaur, MD5, Stephen A. Spector, MD6, Robert Warford, NP7 and Allison Agwu, MD8, (1)Infectious Diseases, Johns Hopkins University, Baltimore, MD, (2)Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, (3)Epidemiology, Johns Hopkins University, Baltimore, MD, (4)Department of Medicine, Oregon Health & Science University, Portland, OR, (5)St. Jude's Children's Research Hospital, Memphis, TN, (6)Pediatrics, University of California, San Diego, La Jolla, CA, (7)St. Luke's Roosevelt Hospital, New York, NY, (8)John Hopkins University School of Medicine, Baltimore, MD

Disclosures:

S. Berry, None

K. Gebo, None

R. Rutstein, None

K. Althoff, None

P. T. Korthuis, None

A. Gaur, None

S. A. Spector, None

R. Warford, None

A. Agwu, None

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