2176. Hospital Usage Attributable to Immune Reconstitution Inflammatory Syndrome in Persons Living with HIV Before and After the 2012 Guideline Update
Session: Poster Abstract Session: HIV: Other Opportunistic Conditions
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • 2016 ID Week Poster PDF.pdf (544.2 kB)
  • Background: Immune Reconstitution Inflammatory Syndrome (IRIS) can manifest with initiation or reintroduction of antiretroviral therapy (ART) in persons living with HIV (PLWH). In 2012, updated treatment guidelines recommended initiation of ART for all PLWH regardless of CD4 count. The purpose of this study was to quantify hospital usage attributable to IRIS before and after the guideline update, and assess the primary diagnosis for PLWH hospitalizations.

    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.

    Peter Liu, MD, Department of Internal Medicine, University of Virginia, Charlottesville, VA, Rebecca Dillingham, MD, MPH, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA and Kathleen Mcmanus, MD, MSCR, Infectious Diseases and International Health, University of Virginia, Charlottesville, VA

    Disclosures:

    P. Liu, None

    R. Dillingham, None

    K. Mcmanus, None

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