Decrease in Incidence Rate of Hospitalizations Due to AIDS-Defining Conditions but Not to Non-AIDS Conditions in PLWHIV on CART in 2008-2018 in Italy

Overview

Journal J Clin Med

Specialty General Medicine

Date 2021 Aug 7

PMID 34362172

Citations 3

Authors

Silvia Nozza

Laura Timelli

Annalisa Saracino

Nicola Gianotti

Claudia Lazzaretti

Alessandro Tavelli

Massimo Puoti

Sergio Lo Caputo

Andrea Antinori

Antonella dArminio Monforte

Cristina Mussini

Enrico Girardi

Icona Foundation Study Group

Affiliations

Soon will be listed here.

Abstract

Background: We aimed to describe the change in the incidence and causes of hospitalization between 2008 and 2018 among persons living with HIV (PLWHIV) who started antiretroviral therapy (ART) from 2008 onwards in Italy.

Methods: We included participants in the ICONA (Italian Cohort Naïve Antiretrovirals) cohort who started ART in 2008. All the hospitalizations occurring during the first 30 days from the start of ART were excluded. Hospitalizations were classified as due to: AIDS-defining conditions (ADC), non-ADC infections and non-infections/non-ADC (i.e., cardiovascular, pulmonary, renal-genitourinary, cancers, gastrointestinal-liver, psychiatric and other diseases). Comparisons of rates across time were assessed using Poisson regression. The Poisson multivariable model evaluated risk factors for hospitalizations, including both demographic and clinical characteristics.

Results: A total of 9524 PLWHIV were included; 6.8% were drug users, 48.9% men-who-have sex with men (MSM), 39.6% heterosexual contacts; 80.8% were males, 42.3% smokers, 16.6% coinfected with HCV and 6.8% with HBV (HBsAg-positive). During 36,157 person-years of follow-up (PYFU), there were 1058 hospitalizations in 747 (7.8%) persons; they had HIV-RNA >50 copies mL in 34.9% and CD4 < 200/mmc in 27%. Causes of hospitalization were 23% ADC, 22% non-ADC infections, 55% non-infections/non-ADC (11% cancers; 9% gastrointestinal-liver; 6% cardiovascular; 5% renal-genitourinary; 5% psychiatric; 4% pulmonary; 15% other). Over the study period, the incidence rate (IR) decreased significantly (from 5.8 per 100 PYFU in 2008-2011 to 2.21 per 100 PYFU in 2016-2018). Age > 50 years, intravenous drug use (IDU), family history of cardiovascular disease, HIV-RNA > 50, CD4 < 200, were associated with a higher hospitalization risk.

Conclusions: In our population of PLWHIV, the rate of hospitalization decreased over time.

Citing Articles

Role of the pharmacist caring for people at risk of or living with HIV in Canada.

Tkachuk S, Ready E, Chan S, Hawkes J, Janzen Cheney T, Kapler J Can Pharm J (Ott). 2024; 157(5):218-239.

PMID: 39310805 PMC: 11412478. DOI: 10.1177/17151635241267350.

All-cause hospitalisation among people living with HIV according to gender, mode of HIV acquisition, ethnicity, and geographical origin in Europe and North America: findings from the ART-CC cohort collaboration.

Rein S, Lampe F, Ingle S, Sterne J, Trickey A, Gill M Lancet Public Health. 2023; 8(10):e776-e787.

PMID: 37777287 PMC: 10851157. DOI: 10.1016/S2468-2667(23)00178-0.

Trends in rates and causes of hospitalization among people living with HIV in the antiretroviral therapy era: A retrospective cohort study in China, 2008-2020.

Liu Y, Hao Y, Xiao J, Wu L, Liang H, Han J Front Public Health. 2022; 10:1000942.

PMID: 36424978 PMC: 9680952. DOI: 10.3389/fpubh.2022.1000942.

References

Mussini C, Galli L, Lepri A, De Luca A, Antinori A, Libertone R . Incidence, timing, and determinants of bacterial pneumonia among HIV-infected patients: data from the ICONA Foundation Cohort. J Acquir Immune Defic Syndr. 2013; 63(3):339-45. DOI: 10.1097/QAI.0b013e318295ab85. View

Yehia B, Fleishman J, Wilson L, Hicks P, Gborkorquellie T, Gebo K . Incidence of and risk factors for bacteraemia in HIV-infected adults in the era of highly active antiretroviral therapy. HIV Med. 2011; 12(9):535-43. DOI: 10.1111/j.1468-1293.2011.00919.x. View

Kalichman S, Ramachandran B, Catz S . Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med. 1999; 14(5):267-73. PMC: 1496573. DOI: 10.1046/j.1525-1497.1999.00334.x. View

dArminio Monforte A, Diaz-Cuervo H, De Luca A, Maggiolo F, Cingolani A, Bonora S . Evolution of major non-HIV-related comorbidities in HIV-infected patients in the Italian Cohort of Individuals, Naïve for Antiretrovirals (ICONA) Foundation Study cohort in the period 2004-2014. HIV Med. 2018; 20(2):99-109. DOI: 10.1111/hiv.12683. View

Spagnuolo V, Poli A, Galli L, Nozza S, Bossolasco S, Cernuschi M . Incidence and Predictors of Serological Treatment Response in Early and Late Syphilis Among People Living With HIV. Open Forum Infect Dis. 2019; 6(1):ofy324. PMC: 6324658. DOI: 10.1093/ofid/ofy324. View

Guaraldi G, Malagoli A, Calcagno A, Mussi C, Celesia B, Carli F . The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65 - 74 years and more than 75 years. BMC Geriatr. 2018; 18(1):99. PMC: 5910563. DOI: 10.1186/s12877-018-0789-0. View

Seng R, Mutuon P, Riou J, Duvivier C, WEISS L, Lelievre J . Hospitalization of HIV positive patients: Significant demand affecting all hospital sectors. Rev Epidemiol Sante Publique. 2017; 66(1):7-17. DOI: 10.1016/j.respe.2017.08.002. View

Hoffmann C, Milovanovic M, Cichowitz C, Kinghorn A, Martinson N, Variava E . Readmission and death following hospitalization among people with HIV in South Africa. PLoS One. 2019; 14(7):e0218902. PMC: 6608975. DOI: 10.1371/journal.pone.0218902. View

Navon L . Hospitalization Trends and Comorbidities Among People With HIV/AIDS Compared With the Overall Hospitalized Population, Illinois, 2008-2014. Public Health Rep. 2018; 133(4):442-451. PMC: 6055283. DOI: 10.1177/0033354918777254. View

10.

Maggi P, Santoro C, Nofri M, Ricci E, De Gennaro N, Bellacosa C . Clusterization of co-morbidities and multi-morbidities among persons living with HIV: a cross-sectional study. BMC Infect Dis. 2019; 19(1):555. PMC: 6593514. DOI: 10.1186/s12879-019-4184-z. View

11.

Lazar R, Kersanske L, Xia Q, Daskalakis D, Braunstein S . Hospitalization Rates Among People With HIV/AIDS in New York City, 2013. Clin Infect Dis. 2017; 65(3):469-476. DOI: 10.1093/cid/cix343. View

12.

Lundgren J, Babiker A, Gordin F, Emery S, Grund B, Sharma S . Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. N Engl J Med. 2015; 373(9):795-807. PMC: 4569751. DOI: 10.1056/NEJMoa1506816. View

13.

Colasanti J, Del Rio C . Declining Hospitalizations Among Persons With Human Immunodeficiency Virus: Time to Leave No Patient Behind. Clin Infect Dis. 2019; 71(7):1624-1626. DOI: 10.1093/cid/ciz1047. View

14.

Wolf M, Davis T, Osborn C, Skripkauskas S, Bennett C, Makoul G . Literacy, self-efficacy, and HIV medication adherence. Patient Educ Couns. 2006; 65(2):253-60. DOI: 10.1016/j.pec.2006.08.006. View

15.

Prosperi M, Cozzi-Lepri A, Castagna A, Mussini C, Murri R, Giacometti A . Incidence of malignancies in HIV-infected patients and prognostic role of current CD4 cell count: evidence from a large Italian cohort study. Clin Infect Dis. 2010; 50(9):1316-21. DOI: 10.1086/651688. View

16.

Palella Jr F, Delaney K, Moorman A, Loveless M, Fuhrer J, Satten G . Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998; 338(13):853-60. DOI: 10.1056/NEJM199803263381301. View

17.

Bellino S, Borghetti A, Lombardi F, Camoni L, Ciccullo A, Baldin G . Trends of hospitalisations rates in a cohort of HIV-infected persons followed in an Italian hospital from 1998 to 2016. Epidemiol Infect. 2019; 147:e89. PMC: 6518563. DOI: 10.1017/S0950268819000098. View

18.

Borges A, Neuhaus J, Sharma S, Neaton J, Henry K, Anagnostou O . The Effect of Interrupted/Deferred Antiretroviral Therapy on Disease Risk: A SMART and START Combined Analysis. J Infect Dis. 2018; 219(2):254-263. PMC: 6306018. DOI: 10.1093/infdis/jiy442. View

19.

Castro-Lima V, Borges I, Joelsons D, Sales V, Guimaraes T, Ho Y . Impact of human immunodeficiency virus infection on mortality of patients who acquired healthcare associated-infection in critical care unit. Medicine (Baltimore). 2019; 98(23):e15801. PMC: 6571254. DOI: 10.1097/MD.0000000000015801. View

20.

Lombardi A, Rossotti R, Moioli M, Merli M, Valsecchi P, Zuccaro V . The impact of HIV infection and men who have sex with men status on hepatitis A infection: The experience of two tertiary centres in Northern Italy during the 2017 outbreak and in the 2009-2016 period. J Viral Hepat. 2019; 26(6):761-765. DOI: 10.1111/jvh.13082. View