All-cause hospitalization according to demographic group in people living with HIV in the current antiretroviral therapy era

Abstract

Objective: We investigated differences in all-cause hospitalization between key demographic groups among people with HIV in the UK in the current antiretroviral therapy (ART) era. Design/Methods: We used data from the Royal Free HIV Cohort study between 2007 and 2018. Individuals were classified into five groups: MSM, Black African men who have sex with women (MSW), MSW of other ethnicity, Black African women and women of other ethnicity. We studied hospitalizations during the first year after HIV diagnosis (Analysis-A) separately from those more than one year after diagnosis (Analysis-B). In Analysis-A, time to first hospitalization was assessed using Cox regression adjusted for age and diagnosis date. In Analysis-B, subsequent hospitalization rate was assessed using Poisson regression, accounting for repeated hospitalization within individuals, adjusted for age, calendar year, time since diagnosis. Results: The hospitalization rate was 30.7/100 person-years in the first year after diagnosis and 2.7/100 person-years subsequently; 52% and 13% hospitalizations, respectively, were AIDS-related. Compared with MSM, MSW and women were at much higher risk of hospitalization during the first year [aHR (95% confidence interval, 95% CI): 2.7 (1.7–4.3), 3.0 (2.0–4.4), 2.0 (1.3–2.9), 3.0 (2.0–4.5) for Black African MSW; other ethnicity MSW; Black African women; other ethnicity women respectively, Analysis-A] and remained at increased risk subsequently [corresponding aIRR (95% CI): 1.7 (1.2–2.4), 2.1 (1.5–2.8), 1.5 (1.1–1.9), 1.7 (1.2–2.3), Analysis-B]. Conclusion: In this setting with universal healthcare, substantial variation exists in hospitalization risk across demographic groups, both in early and subsequent periods after HIV diagnosis, highlighting the need for targeted interventions.

Prospective association of social circumstance, socioeconomic, lifestyle and mental health factors with subsequent hospitalisation over 6–7 year follow up in people living with HIV

“…As reported in a previous study at this London centre [6] , we found that women and heterosexual men of ethnicity other than Black African were at higher risk of hospitalisation compared to MSM. We also found an increased hazard of hospitalisation in individuals over the age of 60, with little variation in risk across the younger age groups.…”

“…We previously reported strong associations between longer time since HIV diagnosis and higher prevalence of physical symptom distress, mental health problems and functional problems, independently of age [34] . Other studies reported some evidence of the opposite association: a negative relationship between time since HIV diagnosis and hospitalisation, [ 7 , 11 ] although a high risk among newly diagnosed individuals may contribute to this [6] . Hepatitis C co-infection has previously been found to predict hospitalisation [ 9 , 17 ].…”

“…The rate of hospitalisation of 5.8/100 person-years in our study population was lower than in some other recent studies in other high income settings [ 13 , [35] , [36] , [37] ]. Our study population had a high median CD4 count (621 cells/μl) and included a low proportion of individuals with recent diagnosis (3.6% of individuals were within their first year after diagnosis at baseline) for whom hospitalisation rates are particularly high [6] . Our data are from a high-income setting, and so are not generalizable to resource-limited settings.…”

“…Previous longitudinal and cross-sectional studies in high-income settings in the cART era have found that demographic factors [6] (including older age [ 4 , [7] , [8] , [9] , [10] , [11] , [12] , [13] ], female gender [ 4 , 9 , 14 ], black or minority ethnicity [ 13 , 15 ]) and clinical HIV markers (including low CD4 count [ 4 , 7 , 9 , 11 , 13 ], high viral load [ 7 , 9 , 11 , 13 , 16 ], Hepatitis C or B coinfection [ 4 , 9 , 17 ] and ART non-adherence [16] ) predict hospitalisation among PLHIV. Other studies found evidence that poor mental health was predictive of hospitalisation [ 8 , 12 , 14 , 18 ]; findings were less consistent for social [ 11 , 14 ], socioeconomic [ 10 , 12 , 14 , 19 ] and lifestyle factors [ 8 , 10 , 12 , 14 , 15 , 18 , 20 ].…”

Prospective Association of Social Circumstance, Socioeconomic, Lifestyle and Mental Health Factors with Subsequent Hospitalisation Over 6-7 Year Follow Up in People Living with HIV

“…Over time, non-AIDS related causes began to account for an increasing proportion of hospitalisations among PLHIV [4,5]. Previous longitudinal and cross-sectional studies in high-income settings in the cART era have found that demographic factors [6] (including older age [4,[7][8][9][10][11][12][13], female gender [4,9,14], black or minority ethnicity [13,15]) and clinical HIV markers (including low CD4 count [4,7,9,11,13], high viral load [7,9,11,13,16], Hepatitis C or B coinfection [4,9,17] and ART non-adherence [16]) predict hospitalisation among PLHIV. Other studies found evidence that poor mental health was predictive of hospitalisation [8,12,14,18]; findings were less consistent for social [11,14], socioeconomic [10,12,14,19] and lifestyle factors [8,10,12,14,15,…”