Rein Sophia M, Smith Colette J, Chaloner Clinton, Stafford Adam, Rodger Alison J, Johnson Margaret A, McDonnell Jeffrey, Burns Fiona, Madge Sara, Miners Alec, Sherr Lorraine, Collins Simon, Speakman Andrew, Phillips Andrew N, Lampe Fiona C
Institute for Global Health, UCL, London, United Kingdom.
Royal Free London NHS Foundation Trust, London, United Kingdom.
EClinicalMedicine. 2020 Dec 1;31:100665. doi: 10.1016/j.eclinm.2020.100665. eCollection 2021 Jan.
Predictors of hospitalisation in people with HIV (PLHIV) in the contemporary treatment era are not well understood.
This ASTRA sub-study used clinic data linkage and record review to determine occurrence of hospitalisations among 798 PLHIV from baseline questionnaire (February to December 2011) until 1 June 2018. Associations of baseline social circumstance, socioeconomic, lifestyle, mental health, demographic and clinical factors with repeated all-cause hospitalisation from longitudinal data were investigated using Prentice-Williams-Peterson models. Associations were also assessed in 461 individuals on antiretroviral therapy (ART) with viral load ≤50 copies/ml and CD4 count ≥500 cells/ µl.
Rate of hospitalisation was 5.8/100 person-years (95% CI: 5.1-6.5). Adjusted for age, demographic group and time with diagnosed HIV, the following social circumstance, socioeconomic, lifestyle and mental health factors predicted hospitalisation: no stable partner (adjusted hazard ratio (aHR)=1.59; 95% CI=1.16-2.20 vs living with partner); having children (aHR=1.50; 1.08-2.10); non-employment (aHR=1.56; 1.07-2.27 for unemployment; aHR=2.39; 1.70-3.37 for sick/disabled vs employed); rented housing (aHR=1.72; 1.26-2.37 vs homeowner); not enough money for basic needs (aHR=1.82; 1.19-2.78 vs enough); current smoking (aHR=1.39; 1.02-1.91 vs never); recent injection-drug use (aHR=2.11; 1.30-3.43); anxiety symptoms (aHRs=1.39; 1.01-1.91, 2.06; 1.43-2.95 for mild and moderate vs none/minimal); depressive symptoms (aHRs=1.67; 1.17-2.38, 1.91; 1.30-2.78 for moderate and severe vs none/minimal); treated/untreated depression (aHRs=1.65; 1.03-2.64 for treated depression only, 1.87; 1.39-2.52 for depressive symptoms only; 1.53; 1.05-2.24; for treated depression and depressive symptoms, versus neither). Associations were broadly similar in those with controlled HIV and high CD4.
Social circumstance, socioeconomic disadvantage, adverse lifestyle factors and poorer mental health are strong predictors of hospitalisation in PLHIV, highlighting the need for targeted interventions and care.
British HIV Association (BHIVA) Research Award (2017); SMR funded by a PhD fellowship from the Royal Free Charity.
在当代治疗时代，人们对艾滋病毒感染者（PLHIV）住院治疗的预测因素了解不足。
这项ASTRA子研究利用临床数据关联和记录审查，确定了798名PLHIV从基线调查问卷（2011年2月至12月）到2018年6月1日期间的住院情况。使用Prentice-Williams-Peterson模型，从纵向数据中研究基线社会环境、社会经济、生活方式、心理健康、人口统计学和临床因素与全因反复住院之间的关联。还对461名接受抗逆转录病毒治疗（ART）且病毒载量≤50拷贝/毫升、CD4细胞计数≥500个/微升的个体进行了关联评估。
住院率为5.8/100人年（95%置信区间：5.1-6.5）。在对年龄、人口统计学组和确诊感染艾滋病毒的时间进行调整后，以下社会环境、社会经济、生活方式和心理健康因素可预测住院情况：没有稳定伴侣（调整后风险比（aHR）=1.59；95%置信区间=1.16-2.20，与有伴侣生活相比）；有孩子（aHR=1.50；1.08-2.10）；无业（失业的aHR=1.56；1.07-2.27；患病/残疾的aHR=2.39；1.70-3.37，与就业相比）；租房（aHR=1.72；1.26-2.37，与自有住房者相比）；基本生活需求资金不足（aHR=1.82；1.19-2.78，与资金充足相比）；当前吸烟（aHR=1.39；1.02-1.91，与从不吸烟相比）；近期注射吸毒（aHR=2.11；1.30-3.43）；焦虑症状（轻度和中度焦虑症状的aHR分别为1.39；1.01-1.91、2.06；1.43-2.95，与无焦虑症状/极少焦虑症状相比）；抑郁症状（中度和重度抑郁症状的aHR分别为1.67；1.17-2.38、1.91；1.30-2.78，与无抑郁症状/极少抑郁症状相比）；接受治疗/未接受治疗的抑郁症（仅接受治疗的抑郁症的aHR为1.65；1.03-2.64，仅存在抑郁症状的aHR为1.87；1.39-2.52；同时存在接受治疗的抑郁症和抑郁症状的aHR为1.53；1.05-2.24，与两者都不存在相比）。在艾滋病毒得到控制且CD4水平较高的人群中，关联情况大致相似。
社会环境、社会经济劣势、不良生活方式因素和较差的心理健康是艾滋病毒感染者住院治疗的有力预测因素，这凸显了针对性干预和护理的必要性。
英国艾滋病毒协会（BHIVA）研究奖（2017年）；SMR由皇家自由慈善机构的博士奖学金资助。
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