Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT.
J Acquir Immune Defic Syndr. 2019 Feb 1;80(2):145-151. doi: 10.1097/QAI.0000000000001904.
HIV, hepatitis C virus (HCV), and alcohol-related diagnoses (ARD) independently contribute increased risk of all-cause hospitalization. We sought to determine annual medical intensive care unit (MICU) admission rates and relative risk of MICU admission between 1997 and 2014 among people with and without HIV, HCV, and ARD, using data from the largest HIV and HCV care provider in the United States.
Veterans Health Administration.
Annual MICU admission rates were calculated among 155,550 patients in the Veterans Aging Cohort Study by HIV, HCV, and ARD status. Adjusted rate ratios and 95% confidence intervals (CIs) were estimated with Poisson regression. Significance of trends in age-adjusted admission rates were tested with generalized linear regression. Models were stratified by calendar period to identify shifts in MICU admission risk over time.
Compared to HIV-/HCV-/ARD- patients, relative risk of MICU admission decreased among HIV-mono-infected patients from 61% (95% CI: 1.56 to 1.65) in 1997-2009% to 21% (95% CI: 1.16 to 1.27) in 2010-2014, increased among HCV-mono-infected patients from 22% (95% CI: 1.16 to 1.29) in 1997-2009% to 54% (95% CI: 1.43 to 1.67) in 2010-2014, and remained consistent among patients with ARD only at 46% (95% CI: 1.42 to 1.50). MICU admission rates decreased by 48% among HCV-uninfected patients (P-trend <0.0001) but did not change among HCV+ patients (P-trend = 0.34).
HCV infection and ARD remain key contributors to MICU admission risk. The impact of each of these conditions could be mitigated with combination of treatment of HIV, HCV, and interventions targeting unhealthy alcohol use.
HIV、丙型肝炎病毒（HCV）和与酒精相关的诊断（ARD）独立增加全因住院的风险。我们试图使用美国最大的 HIV 和 HCV 护理提供者的数据，确定 1997 年至 2014 年间 HIV 阳性、HCV 阳性和 ARD 患者的年度重症监护病房（MICU）入院率和 MICU 入院的相对风险。
退伍军人健康管理局。
通过 HIV、HCV 和 ARD 状态，在退伍军人老龄化队列研究中的 155550 名患者中计算每年 MICU 入院率。使用泊松回归估计调整后的比率比和 95%置信区间（CI）。通过广义线性回归检验年龄调整后入院率趋势的显著性。按日历期分层模型，以确定 MICU 入院风险随时间的变化。
与 HIV-/HCV-/ARD-患者相比，HIV 单一感染患者的 MICU 入院相对风险从 1997-2009 年的 61%（95%CI：1.56 至 1.65）降至 2010-2014 年的 21%（95%CI：1.16 至 1.27），HCV 单一感染患者的 MICU 入院相对风险从 1997-2009 年的 22%（95%CI：1.16 至 1.29）增至 2010-2014 年的 54%（95%CI：1.43 至 1.67），而仅 ARD 患者的相对风险保持在 46%（95%CI：1.42 至 1.50）不变。HCV 阴性患者的 MICU 入院率下降了 48%（P 趋势<0.0001），但 HCV 阳性患者的 MICU 入院率没有变化（P 趋势=0.34）。
HCV 感染和 ARD 仍然是 MICU 入院风险的主要因素。通过联合治疗 HIV、HCV 和针对不健康饮酒的干预措施，这些条件中的每一种都可能减轻其影响。
