乙型肝炎合并感染对多中心 HIV 感染者住院率和住院原因的影响。
Impact of hepatitis coinfection on hospitalization rates and causes in a multicenter cohort of persons living with HIV.
机构信息
Departments of *Medicine and †Pediatrics Johns Hopkins University, Baltimore, MD; and ‡Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD.
出版信息
J Acquir Immune Defic Syndr. 2014 Apr 1;65(4):429-37. doi: 10.1097/QAI.0000000000000059.
BACKGROUND
Chronic viral hepatitis is a potentially important determinant of health care utilization among persons living with HIV. We describe hospitalization rates and reasons for hospitalization among persons living with HIV stratified by coinfection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV).
METHODS
Laboratory, demographic, and hospitalization data were obtained for all patients receiving longitudinal HIV care during 2010 at 9 geographically diverse sites. Hepatitis serostatus was assessed by hepatitis B surface antigen and/or hepatitis C antibody. ICD-9 codes were used to assign hospitalizations into diagnostic categories. Negative binomial regression was used to assess factors associated with all-cause and diagnostic category-specific hospitalizations.
RESULTS
A total of 2793 hospitalizations were observed among 12,819 patients. Of these patients, 49.3% had HIV monoinfection, 4.1% HIV/HBV, 15.4% HIV/HCV, 2.5% HIV/HBV/HCV, and 28.7% unknown hepatitis serostatus. Compared with HIV monoinfection, the risk of all-cause hospitalization was increased with HIV/HBV [adjusted incidence rate ratio 1.55 (1.17 to 2.06)], HIV/HCV [1.45 (1.21 to 1.74)], and HIV/HBV/HCV [1.52 (1.04 to 2.22)]. Risk of hospitalization for non-AIDS-defining infection was also higher among patients with HIV/HBV [2.07 (1.38 to 3.11)], HIV/HCV [1.81 (1.36 to 2.40)], and HIV/HBV/HCV [1.96 (1.11 to 3.46)]. HIV/HBV was associated with hospitalization for gastrointestinal/liver disease [2.55 (1.30 to 5.01)]. HIV/HCV was associated with hospitalization for psychiatric illness [1.89 (1.11 to 3.26)].
CONCLUSIONS
HBV and HCV coinfection are associated with increased risk of all-cause hospitalization and hospitalization for non-AIDS-defining infections, as compared with HIV monoinfection. Policy-makers and third-party payers should be aware of the heightened risk of hospitalization associated with coinfection when allocating health care resources and considering models of health care delivery.
背景
慢性病毒性肝炎是影响 HIV 感染者医疗保健利用的一个重要潜在决定因素。我们描述了按乙型肝炎病毒（HBV）和/或丙型肝炎病毒（HCV）合并感染分层的 HIV 感染者的住院率和住院原因。
方法
从 2010 年在 9 个地理位置不同的地点接受纵向 HIV 护理的所有患者中获得实验室、人口统计学和住院数据。通过乙型肝炎表面抗原和/或丙型肝炎抗体检测来确定肝炎血清状态。ICD-9 代码用于将住院治疗归入诊断类别。使用负二项回归评估与全因和诊断类别特异性住院相关的因素。
结果
在 12819 名患者中观察到 2793 例住院。这些患者中，49.3%为 HIV 单一感染，4.1%为 HIV/HBV，15.4%为 HIV/HCV，2.5%为 HIV/HBV/HCV，28.7%为未知的肝炎血清状态。与 HIV 单一感染相比，HIV/HBV（调整后的发病率比 1.55 [1.17 至 2.06]）、HIV/HCV（1.45 [1.21 至 1.74]）和 HIV/HBV/HCV（1.52 [1.04 至 2.22]）合并感染的全因住院风险增加。HIV/HBV（2.07 [1.38 至 3.11]）、HIV/HCV（1.81 [1.36 至 2.40]）和 HIV/HBV/HCV（1.96 [1.11 至 3.46]）合并感染患者非艾滋病定义性感染的住院风险也更高。HIV/HBV 与胃肠道/肝脏疾病住院治疗相关（2.55 [1.30 至 5.01]）。HIV/HCV 与精神疾病住院治疗相关（1.89 [1.11 至 3.26]）。
结论
与 HIV 单一感染相比，HBV 和 HCV 合并感染与全因住院和非艾滋病定义性感染住院的风险增加相关。在分配医疗保健资源和考虑医疗保健提供模式时，政策制定者和第三方付款人应意识到合并感染相关的住院风险增加。
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