Methods: Subjects were PLWH who were 18-89 years old and hospitalized between November 1, 2009 and July 31, 2014. Equivalent time periods of 28.5 months pre and post-guideline update were considered. IRIS-attributable hospitalizations were identified by ICD9 codes and medical record searches with subsequent review and confirmation. For non IRIS-attributable hospitalizations, discharge summaries were reviewed for primary discharge diagnosis. IRIS-attributable hospital days were compared pre and post-guideline using a chi-square test and mean IRIS-attributable length of stay for the pre and post-guideline period were compared using a t-test.
Results: A total of 278 PLWH were hospitalized 521 times throughout our study period. The pre-guideline period had 9 PLWH with 12 IRIS-attributable hospitalizations while the post-guideline period had 6 PLWH with 9 IRIS-attributable hospitalizations. A larger proportion of IRIS-attributable hospital days was observed in the pre-guideline compared to post-guideline period (7.5% vs 4.2%; p <0.0001). Average length of stay for IRIS-attributable hospitalizations was longer than for other diagnoses, particularly during the pre-guideline period (11.1 vs. 6.4, p=0.025). The most common reasons for PLWH hospitalizations were non-AIDS defining infection, AIDS defining malignancy, and gastrointestinal.
Conclusion: IRIS continues to pose a considerable burden on the healthcare system, but at one academic center, there was a lower percentage of IRIS-attributable hospital days in the post-guideline period compared with the pre-guideline period. The burden of IRIS may decrease over time as more PLWH are started on ART earlier in the course of infection before advanced immunocompromise occurs.
K. Mcmanus, None