1240. Impact of Hepatitis Serostatus on Primary Care, Mental Health, Emergency Room and Inpatient Utilization in Persons Living with HIV
Session: Oral Abstract Session: HIV: Detection, Linkage, and Utilization
Saturday, October 5, 2013: 11:06 AM
Room: The Moscone Center: 250-262

Background: Comorbid conditions are important determinants of healthcare utilization among persons living with HIV (PLWH). We hypothesized that PLWH with comorbid hepatitis B virus (HBV), hepatitis C virus (HCV), or both have more frequent primary care (PC), mental health (MH), emergency room (ER) and inpatient (IP) visits than HIV mono-infected persons.

Methods: Laboratory, demographic, and utilization data were obtained for patients receiving longitudinal HIV care between 2006 and 2011 at 5 US sites in the HIV Research Network. Hepatitis serostatus was assessed by detection of hepatitis B surface antigen and/or hepatitis C antibody. Negative binomial regression with GEE was used to assess factors associated with utilization.

Results: Of 15,046 patients with complete hepatitis serologic data, 75% were male, 28% White, 46% Black and 23% Hispanic with a median age at enrollment of 38 (IQR 31-45) years. 73% had HIV mono-infection, 5.5% HIV/HBV, 20% HIV/HCV and 1.1% HIV/HBV/HCV. IDU was reported in 15% of patients overall with higher percentages in the HIV/HCV (54%) and HIV/HBV/HCV (56%) groups. MSM comprised 45% of patients with a higher percentage in the HIV/HBV group (63%). Median baseline CD4 ranged from 267 (HIV/HBV) to 333 (HIV) cells/mm3.

Unadjusted utilization rates were generally higher for patients with comorbid hepatitis than for patients with HIV mono-infection (Figure 1). After adjustment for demographics, HIV risk factor, CD4, HIV-1 RNA, ART use and insurance type, rate of IP visits was increased with HIV/HBV (IRR 1.40 [1.21-1.62]), HIV/HCV (1.35 [1.23-1.49]) and HIV/HBV/HCV (1.50 [1.15-1.94]) compared to HIV mono-infection (Figure 2). Similarly, rate of ER visits was increased with HIV/HBV (IRR 1.36 [1.12-1.65]), HIV/HCV (1.72 [1.52-1.93]), and HIV/HBV/HCV (1.42 [1.12-1.81]). MH visits were increased with HIV/HCV (IRR 1.25 [1.11-1.40]). No significant differences in PC visits were seen.

Conclusion: Compared to persons with HIV mono-infection, PLWH with hepatitis co- and tri-infection have higher rates of ER and IP utilization. These types of healthcare utilization are costly and often indicate advanced illnesses. Strategies are needed to reduce ER and IP utilization among PLWH with comorbid hepatitis.

Unadjusted Healthcare Utilization Rates.jpg

Trevor Crowell, MD, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, Stephen Berry, MD PhD, Johns Hopkins University School of Medicine, Baltimore, MD, Kelly Gebo, MD, MPH, John Hopkins University School of Medicine, Baltimore, MD and the HIV Research Network


T. Crowell, None

S. Berry, None

K. Gebo, Tibotec: Grant Investigator, Grant recipient
Tibotec: Consultant, Salary
BMS: Consultant, Salary

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