Background: Effective antiretroviral therapy has increased survival in persons with HIV (PWH). Over 45% of PWH are now over 50 years old, and comorbidities of aging are becoming more prevalent. The objective of this study was to evaluate hospitalization rates and causes for hospitalization among PWH in longitudinal HIV care by age.
Methods: Hospitalization rates and diagnoses were determined in PWH receiving longitudinal care at 13 sites in the HIV Research Network between 2014-2015. Using AHRQ Clinical Classification Software, we divided inpatient ICD9 discharge diagnoses into diagnostic categories. Multivariate negative binomial regression was performed to assess for factors associated with overall hospitalization and for each diagnostic category.
Results: The sample included 20,608 patients, 73% male, 46% black, 21% Hispanic, 47% MSM, and 12% IDU. Median age was 48 yo [range 18-89] of which 32% were 50-59 yo, 12% were ≥ 60 yo. 75% had CD4 ≥ 350, 81% had HIV-1 RNA < 50 copies. 20% had private insurance, 36% Medicaid, 10% Medicare, and 5% were uninsured. All cause hospitalization rate for 2014-2015 was 201/1000 person years (PY). Non-AIDS defining infection (non-ADI) was the leading cause for admission (47/1000 PY), followed by cardiovascular disease (CVD) (22/1000 PY), psychiatric (14/1000 PY), endocrine (14/1000 PY) and ADI (13/1000 PY). In multivariate analysis, the incidence rate ratio (IRR) for all-cause hospitalization increased by age group (18-29 yo reference): 30-39 yo IRR 1.05 (95% CI 0.88, 1.26), 40-49 yo IRR 1.28 (1.08, 1.51), 50-59 yo IRR 1.43 (1.22, 1.69), and 60 yo or greater IRR 1.97 (1.64, 2.37). Hospitalization rates increased significantly by age group for CV, GU, pulmonary, endocrine, and oncology diagnostic categories. Rates did not differ by age for non-ADI infection, GI and mental health diagnostic categories.
Conclusion: The hospitalization rates for noncommunicable diseases (NCDs) increase as PWH age. There is an increase CV hospitalizations among older PWH. ADI accounted for fewer hospitalizations than many chronic diseases. Our results suggest that HIV experts, primary care providers and other specialists may need to work together to optimize the care of older PWH.
C. Somboonwit, None
A. E. Nijhawan, Gilead: Consultant , Research support .
R. Moore, None
K. Gebo, None