Hospitalizations among HIV controllers and persons with medically controlled HIV in the U.S. Military HIV Natural History Study

Crowell, Trevor A; Ganesan, Anuradha; Berry, Stephen; Deiss, Robert; Agan, Brian K.; Okulicz, Jason F.

doi:10.7448/ias.19.1.20524

Cited by 26 publications

(52 citation statements)

References 34 publications

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“…Likewise, Pereyra et al [ 20 ] reported that elite controllers had increased coronary and immune activation. By contrast, in younger population (median age 27 years) such higher rate of cardiovascular hospitalization rates were not observed [ 21 ]. We found no association between the baseline CD4/CD8 ratio and loss of HIC status, whereas HIV RNA values 50–500 cp/mL were associated with a 5.5-fold higher risk of progression compared to ≤50 cp/mL.…”

Section: Discussionmentioning

confidence: 99%

Loss of long-term non-progressor and HIV controller status over time in the French Hospital Database on HIV - ANRS CO4

Grabar¹,

Selinger-Leneman²,

Abgrall³

et al. 2017

PLoS ONE

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ObjectivesWe studied the frequency and risk factors for loss of long-term non-progressor (LTNP) and HIV controller (HIC) status among patients identified as such in 2005 in the French Hospital Database on HIV (FHDH-ANRS CO4).MethodsWe selected patients who were treatment-naïve and asymptomatic in 2005 (baseline). Those with ≥8 years of known HIV infection and a CD4 cell nadir ≥500/mm3 were classified as LTNP and those with ≥10 years of known HIV infection and 90% of plasma viral load (VL) values ≤500 copies/ml in the absence of cART as HIC. cART initiation without loss of status and death from non AIDS-defining causes were considered as competing events.ResultsAfter 5 years of follow-up, 33% (95%CI; 27–42) of 171 LTNP patients and 17% (95%CI; 10–30) of 72 HIC patients had lost their status. In multivariable analyses, loss of LTNP status was associated with lower baseline CD4 cell counts and CD4/CD8 ratios. Only VL was significantly associated with loss of HIC status after adjustment for the baseline CD4 cell count, the CD4/CD8 ratio, and concomitant LTNP status. The hazard ratio for loss of HIC status was 5.5 (95%CI, 1.5–20.1) for baseline VL 50–500 vs ≤50 cp/mL, after adjustment for the baseline CD4 cell count.ConclusionsOne-third of LTNP and one-fifth of HIC patients lost their status after 5 years of follow-up, raising questions as to the possible benefits and timing of ART initiation in these populations.

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Section: Discussionmentioning

confidence: 99%

Loss of long-term non-progressor and HIV controller status over time in the French Hospital Database on HIV - ANRS CO4

Grabar¹,

Selinger-Leneman²,

Abgrall³

et al. 2017

PLoS ONE

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“…Prior studies have not been consistent in demonstrating the primary diagnoses that drive inpatient utilization. One cohort study of HIV-infected military personnel between 2000 and 2013 found that non-AIDS-defining infections were the most common cause of hospital admission [ 16 ]. Other studies suggest that AID-related diagnoses, non-AIDS-related cancers, and liver disease account for the majority of deaths in HIV-infected persons during a similar time period [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Human immunodeficiency virus/HCV coinfection carries morbidity and mortality risks independent of liver disease, and it is associated with a higher risk of insulin resistance, diabetes mellitus, and renal disease than HIV infection alone [ 14 , 15 ]. Studies examining HIV-infected and HIV/HCV-coinfected patients suggest that these nonliver-related comorbidities, as well as psychiatric/substance use disorders and non-acquired immune deficiency syndrome (AIDS)-associated infections, may be major contributors to healthcare utilization (HCU) [ 16 – 18 ].…”

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confidence: 99%

Patterns of Healthcare Utilization Among Veterans Infected With Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) and Coinfected With HIV/HCV: Unique Burdens of Disease

Katrak

Park

Woods

et al. 2016

Open Forum Infectious Diseases

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Background. Hepatitis C virus (HCV) infection is a leading cause of cirrhosis and the primary cause of liver transplantation in the United States, and coinfection with human immunodeficiency virus (HIV) increases the risk of comorbidities. However, healthcare utilization (HCU) patterns among HIV/HCV-coinfected patients are poorly understood. This study compared the rates of HCU and reasons for hospital admission among HCV-infected, HIV-infected, and HIV/HCV-coinfected veterans.Methods. Hepatitis C virus- and HIV-infected and HIV/HCV-coinfected veterans in care with the Department of Veterans Affairs (VA) from 1998 to 2009 (n = 335 371, n = 28 179, n = 13 471, respectively) were identified by HIV- and HCV-associated International Classification of Diseases, Ninth Revision codes from the clinical case registry. We assessed rates of HCU using emergency department (ED) visits, outpatient visits, and hospitalization and primary diagnoses associated with hospitalization. Independent risk factors associated with hospitalization were also examined.Results. Rates of outpatient and ED visits increased over the 11-year study period for all groups, with inpatient admission rates remaining stable. The HCU rates were consistently higher for the coinfected than other cohorts. The primary reason for hospital admission for all groups was psychiatric disease/substance use, accounting for 44% of all admissions. Nadir CD4 <350 cells/mm3 was associated with higher rates of hospitalization versus nadir CD4 >500 cells/mm3.Conclusions. As the current population of HCV-infected, HIV-infected, and HIV/HCV-coinfected veterans age, they will continue to place a substantial and increasing demand on the US healthcare system, particularly in their utilization of ED and outpatient services. These data suggest the need for an ongoing investment in mental health and primary care within the VA healthcare system.

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“…Some studies have analysed the risk of nADEs in different cohorts of controllers (27)(28)(29)(30)(31)(32) (summarized in Table 1). Crowell et al studied 149 "elite" controllers and reported that they were at a greater risk of all-cause hospitalizations (especially, hospitalizations for psychiatric and cardiovascular diseases), relative to PLWH on ART (29).…”

Section: What Is the Justification For Treating Controllers?mentioning

confidence: 99%

HIV controllers: to treat or not to treat? Is that the right question?

et al. 2019

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The term "HIV controller refers to the small proportion of HIV-infected individuals who are able to spontaneously control viremia at very low levels. One major unresolved question is whether controllers should receive antiretroviral therapy (ART), given that the international guidelines recommend treatment for all HIV-infected individuals. Differences in the definitions of a controller (in terms of the viral load cutoff and the duration of viral control) and contrasting reports on CD4 T cell decline, chronic immune activation, the cardiovascular risk, and loss of viral control in controllers have prevented the development of a consensus view. In the present review, we (i) discuss the indications of initiating ART in controllers, (ii) highlight the impact of the various definitions of HIV control, and (iii) emphasize the value of personalized care/patient-centred approaches for controllers.

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Hospitalizations among HIV controllers and persons with medically controlled HIV in the U.S. Military HIV Natural History Study

Cited by 26 publications

References 34 publications

Loss of long-term non-progressor and HIV controller status over time in the French Hospital Database on HIV - ANRS CO4

Loss of long-term non-progressor and HIV controller status over time in the French Hospital Database on HIV - ANRS CO4

Patterns of Healthcare Utilization Among Veterans Infected With Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) and Coinfected With HIV/HCV: Unique Burdens of Disease

HIV controllers: to treat or not to treat? Is that the right question?

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