Davy-Mendez Thibaut, Napravnik Sonia, Hogan Brenna C, Althoff Keri N, Gebo Kelly A, Moore Richard D, Horberg Michael A, Silverberg Michael J, Gill M John, Crane Heidi M, Marconi Vincent C, Bosch Ronald J, Colasanti Jonathan A, Sterling Timothy R, Mathews W Christopher, Mayor Angel M, Nanditha Ni Gusti Ayu, Buchacz Kate, Li Jun, Rebeiro Peter F, Thorne Jennifer E, Nijhawan Ank, van Duin David, Wohl David A, Eron Joseph J, Berry Stephen A
Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Infect Dis. 2021 Jun 15;223(12):2113-2123. doi: 10.1093/infdis/jiaa661.
To assess the possible impact of antiretroviral therapy improvements, aging, and comorbidities, we examined trends in all-cause and cause-specific hospitalization rates among persons with HIV (PWH) from 2005 to 2015.
In 6 clinical cohorts, we followed PWH in care (≥1 outpatient CD4 count or HIV load [VL] every 12 months) and categorized ICD codes of primary discharge diagnoses using modified Clinical Classifications Software. Poisson regression estimated hospitalization rate ratios for calendar time trends, adjusted for demographics, HIV risk factor, and annually updated age, CD4, and VL.
Among 28 057 patients (125 724 person-years), from 2005 to 2015, the median CD4 increased from 389 to 580 cells/µL and virologic suppression from 55% to 85% of patients. Unadjusted all-cause hospitalization rates decreased from 22.3 per 100 person-years in 2005 (95% confidence interval [CI], 20.6-24.1) to 13.0 in 2015 (95% CI, 12.2-14.0). Unadjusted rates decreased for almost all diagnostic categories. Adjusted rates decreased for all-cause, cardiovascular, and AIDS-defining conditions, increased for non-AIDS-defining infection, and were stable for most other categories.
Among PWH with increasing CD4 counts and viral suppression, unadjusted hospitalization rates decreased for all-cause and most cause-specific hospitalizations, despite the potential effects of aging, comorbidities, and cumulative exposure to HIV and antiretrovirals.
为评估抗逆转录病毒疗法的改善、衰老和合并症可能产生的影响，我们研究了2005年至2015年期间艾滋病毒感染者（PWH）的全因和特定病因住院率趋势。
在6个临床队列中，我们对接受治疗的PWH进行随访（每12个月至少有1次门诊CD4细胞计数或艾滋病毒载量[VL]），并使用改良的临床分类软件对主要出院诊断的国际疾病分类代码进行分类。泊松回归估计日历时间趋势的住院率比，并根据人口统计学、艾滋病毒风险因素以及每年更新的年龄、CD4和VL进行调整。
在28057名患者（125724人年）中，从2005年到2015年，CD4中位数从389个细胞/微升增加到580个细胞/微升，病毒学抑制患者的比例从55%增加到85%。未经调整的全因住院率从2005年的每100人年22.3例（95%置信区间[CI]，20.6 - 24.1）降至2015年的13.0例（95%CI，12.2 - 14.0）。几乎所有诊断类别的未经调整率均下降。经调整的全因、心血管和艾滋病定义疾病的住院率下降，非艾滋病定义感染的住院率上升，大多数其他类别保持稳定。
在CD4计数增加和病毒得到抑制的PWH中，尽管存在衰老、合并症以及艾滋病毒和抗逆转录病毒药物累积暴露的潜在影响，但全因和大多数特定病因住院的未经调整住院率仍有所下降。
