Background: HIV-associated illness in the US has evolved with the advent of antiretroviral therapy and aging of the HIV-infected population. While changes in the causes of mortality in these patients are well documented, reasons for hospitalization and costs associated with hospital stays are not well studied at the national level.
Methods: We collected billing and demographic data of 84,666 HIV-associated hospitalizations across 3,564 hospitals nationwide using the 2012 and 2013 National Inpatient Sample, and used principal component analysis to arrive at predominant themes of HIV-associated hospitalization. Components with eigenvalues greater than one were retained, and orthogonal rotation was performed to identify variables that significantly loaded each component. Estimated hospital costs were determined by multiplying inflation-adjusted charges with hospital-specific cost-to-charge ratios and inverse wage indexes, and average costs associated with principal components were computed.
Results: Kidney disease predominated as a theme for HIV-associated hospitalization and accounted for 9% of the total variance. This was followed by liver disease, opportunistic infections with Pneumocystis and Candida, septicemia, and substance abuse, which accounted for 7%, 6%, 5% and 4% of the total variance respectively. Other significant contributors to hospitalization were heart disease, low socioeconomic status, complicated diabetes mellitus, and other opportunistic infections. The highest costs were associated with septicemia which averaged $25,557 per hospitalization, whereas the lowest costs were associated with substance abuse which averaged $7,534 per hospitalization.
Conclusion: Kidney and liver disease are important components of HIV-associated hospitalization in the current era reflecting an aging population overlain with complications from HIV and viral hepatitis. Opportunistic infections continue to be major contributors to hospitalization indicating ongoing challenges in access and adherence to antiretroviral therapy. Research efforts should focus on ameliorating HIV-related kidney and liver disease, as well as implementing strategies to promote early diagnosis and treatment of HIV.