Decrease in Incidence Rate of Hospitalizations Due to AIDS-Defining Conditions but Not to Non-AIDS Conditions in PLWHIV on cART in 2008–2018 in Italy

Abstract

Background: We aimed to describe the change in the incidence and causes of hospitalization between 2008 and 2018 among persons living with HIV (PLWHIV) who started antiretroviral therapy (ART) from 2008 onwards in Italy. Methods: We included participants in the ICONA (Italian Cohort Naïve Antiretrovirals) cohort who started ART in 2008. All the hospitalizations occurring during the first 30 days from the start of ART were excluded. Hospitalizations were classified as due to: AIDS-defining conditions (ADC), non-ADC infections and non-infections/non-ADC (i.e., cardiovascular, pulmonary, renal-genitourinary, cancers, gastrointestinal-liver, psychiatric and other diseases). Comparisons of rates across time were assessed using Poisson regression. The Poisson multivariable model evaluated risk factors for hospitalizations, including both demographic and clinical characteristics. Results: A total of 9524 PLWHIV were included; 6.8% were drug users, 48.9% men-who-have sex with men (MSM), 39.6% heterosexual contacts; 80.8% were males, 42.3% smokers, 16.6% coinfected with HCV and 6.8% with HBV (HBsAg-positive). During 36,157 person-years of follow-up (PYFU), there were 1058 hospitalizations in 747 (7.8%) persons; they had HIV-RNA >50 copies mL in 34.9% and CD4 < 200/mmc in 27%. Causes of hospitalization were 23% ADC, 22% non-ADC infections, 55% non-infections/non-ADC (11% cancers; 9% gastrointestinal-liver; 6% cardiovascular; 5% renal-genitourinary; 5% psychiatric; 4% pulmonary; 15% other). Over the study period, the incidence rate (IR) decreased significantly (from 5.8 per 100 PYFU in 2008–2011 to 2.21 per 100 PYFU in 2016–2018). Age > 50 years, intravenous drug use (IDU), family history of cardiovascular disease, HIV-RNA > 50, CD4 < 200, were associated with a higher hospitalization risk. Conclusions: In our population of PLWHIV, the rate of hospitalization decreased over time.

All-cause hospitalisation among people living with HIV according to gender, mode of HIV acquisition, ethnicity, and geographical origin in Europe and North America: findings from the ART-CC cohort collaboration

“…Whereas the Canadian study found a lower risk for HIV-related and all-cause hospitalisation in migrants compared with non-migrants, 37 the Italian study found some evidence that non-Italian nationality was associated with an increased risk of all-cause and non-AIDS-related hospitalisation but not with AIDS-defining hospitalisation. 3 A previous ART-CC analysis found lower mortality in migrants from sub-Saharan Africa, Asia, or other western (ie, Europe [ for the North American analysis], the USA and Canada [ for the European analysis], Australia, and New Zealand) countries but not from Latin America or the Middle Eastern or north African regions. 38 There are two competing potential hypotheses.…”

Trends in rates and causes of hospitalization among people living with HIV in the antiretroviral therapy era: A retrospective cohort study in China, 2008–2020

“…A study on a European population of HIV-infected patients from 2001 to 2009 reported considerable mortality associated with non-AIDS events, exceeding that of AIDS events. In high-income countries, nADEs have become the most common reason for hospitalization, and the rates for nADE-related hospitalizations have remained stable or increased over the past two decades ( 32 – 35 ). Our adjusted analysis showed that the nADE-related hospitalization rates were low and stable and mainly happened in ART-experienced patients.…”