United States National Trends in Mortality, Length of Stay (LOS) and Associated Costs of Cognitive Impairment in HIV Population from 2005 to 2014

Abstract

We evaluated national trends of in-hospital discharge rates, mortality outcomes, health care costs, length of stay in HIV patients with cognitive disorders. Neurological involvement in HIV is commonly associated with cognitive impairment termed as HIV-associated neurocognitive disorder (HAND) which includes a spectrum of neurocognitive dysfunction associated with HIV infection. Although severe and progressive neurocognitive impairment has become rare in HIV patients in the era of potent antiretroviral therapy, a majority of HIV patients have mild to moderate degree of neurocognitive impairment. Study population for this analysis was derived from the Nationwide Inpatient Sample from 2005 to 2014. Patients with ICD-9 code of HIV (042) with discharge diagnosis (Dx) listed top 1 through 5 were included in the analysis. Within this population, we identified patients with cognitive impairment using ICD-9 codes of 294 (persistent mental disorders; organic psychotic brain syndromes (chronic), 323.9 (encephalitis, myelitis, and encephalomyelitis), 331.83 (mild cognitive impairment) with Dx listed from 1 to 25. Patient variables obtained included: age, race, gender, length of stay, in-hospital mortality and insurance status. Hospital level variables included teaching status, location and region of country. SAS 9.4 software was used for data analysis. Comparisons of variables between hospitalized HIV patients with and without HAND showed significant increase in cost per hospital admissions, longer hospital stay and higher risk of mortality in patients with HAND.

Neurocognitive status and risk of mortality among people living with human immunodeficiency virus: an 18-year retrospective cohort study

“…Unlike our study, none of the previous studies have reported an interaction between age and neurocognitive status in relation to mortality. However, studies have observed independent associations between age and mortality and age and neurocognitive status 23,34 . Specifically, in the pre-cART era, studies had found NCI to be an independent risk factor for mortality 15 .…”

Characterization of HIV-Associated Neurocognitive Impairment in Middle-Aged and Older Persons With HIV in Lima, Peru

“…Moreover, there are no standard cognitive screening protocols nor clinical management guidelines for PWH with NCI despite 70,000 PWH living in Peru, with 60% currently having access to ART (20,21). Cognitive decline in the general population presents significant medical, social, and economic challenges (22), and Peruvian health systems, like those of many Latin American countries, will face challenges with the increasing burden of NCI (1). Documenting the prevalence of HAND and associated risk factors among Peruvians with HIV is the first step in identifying the burden of this disease, which may lead to implementation of public policies that can help PWH living with NCI to improve their quality of life.…”

HIV-1 Vpr-Induced Proinflammatory Response and Apoptosis Are Mediated through the Sur1-Trpm4 Channel in Astrocytes

“…More than 50% of HIV-infected individuals are afflicted with HAND. While severe and progressive HAND has decreased significantly due to cART, mild-to-moderate neurocognitive impairment often persists and contributes to increased prevalence of delirium, dementia, and depression, all of which can contribute to increased rates of suicide among HIV-infected patients ( 1 ). Indeed, the risk of suicide in HIV-infected persons is significantly higher than in HIV-non-infected counterparts ( 2 , 3 ).…”