Among patients with HIV who are in care, the rate of hospitalization for any cause declined substantially during a recent 10-year period, according to study findings published in The Journal of Infectious Diseases.

Hospitalization rates declined despite the potential effects of aging, comorbidities and cumulative exposure to HIV and antiretrovirals, researchers said.

In their study, Thibaut Davy-Mendez, PhD, a post-doctoral fellow in the department of psychiatry and behavioral sciences at the University of California, San Francisco, Stephen A. Berry, MD, PhD, associate professor of medicine at Johns Hopkins University School of Medicine, and colleagues examined trends in all-cause and cause-specific hospitalization rates between 2005 and 2015 to assess the possible impact of ART improvements, aging and comorbidities on hospitalizations among people living with HIV (PLWH) who are receiving care.

The study included PLWH receiving care in six clinical cohorts in the United States and Canada.

Among the 28,057 patients ultimately included in the study, the median CD4 increased from 389 to 580 cells/µL, and the proportion of patients who were virologically suppressed rose from 55% to 85%.

According to the researchers, the unadjusted all-cause hospitalization rate decreased from 22.3 per 100 person years in 2005 (95% CI, 20.6-24.1) to 13 per 100 person years in 2015 (95% CI, 12.2-14). Additionally, unadjusted rates decreased for almost all diagnostic categories, whereas adjusted rates decreased for all-cause, cardiovascular and AIDS-defining conditions. They increased for non-AIDS-defining infection and were stable for most other categories.

According to Davy-Mendez and Berry, previous data showed similar results. Data from the 2000s revealed a decrease in hospitalization rates among PLWH but slight increases in cardiovascular and kidney disease hospitalizations. Additionally, more recent studies in North Carolina and Italy found a continued decrease in hospitalization rates among people with HIV through 2016.

“Our study is the most recent work reporting hospitalization trends across a large number of people living with HIV in the United States and Canada,” they said. “Based on previous studies, we expected that non-AIDS-defining infections would make up a substantial percentage of hospitalization reasons. However, we did not expect to see a small increase in the adjusted hospitalization rate [of] non-AIDS-defining infections.”

They said this finding will require further investigation to understand the drivers of these infections and possible ways to prevent them.

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The prevalence of HIV among patients hospitalized with coronavirus disease 2019 (COVID-19) appears to be higher compared with the general population, suggesting an increased susceptibility to COVID-19 among people with HIV, according to research presented at IDWeek, held virtually from October 21 to 25, 2020.

To determine the prevalence of HIV in patients with COVID-19 and the relationship between people with HIV and higher COVID-19 mortality rates, researchers conducted a meta-analysis using PubMed, Scopus, OVID, Web of Science, and Cochrane Library databases, including grey literature from January 1 to June 15.

Of the 14 studies analyzed, 8 were in the United States, 3 in Spain, 1 in China, 1 in Italy, and 1 in Germany. Of the 144,795 patients hospitalized with COVID-19, 592 included people with HIV.

The pooled prevalence of HIV in patients with COVID-19 was 1.22% (95% CI, 0.61-2.43%), double the prevalence of 0.65% (95% CI, 0.48-0.89%) in the general population. The pooled HIV prevalence among patients with COVID-19 in the United States was 1.43% (95% CI, 0.98-2.07%), which was significantly higher than Spain’s prevalence of 0.26% (95% CI, 0.23-0.29%), but not significantly higher than China’s prevalence of 0.99% (95% CI, 0.25-3.85%).

The pooled mortality rate among hospitalized patients with COVID-19 and HIV was 14.09% (95% CI, 5.78-30.50%), and the rate was highest in the Unites States compared with the other countries.

Findings suggest that people with HIV may have a higher susceptibility to COVID-19. While mortality rates are high, they “vary significantly across countries,” investigators concluded.

Reference

Ssentongo P, Heilbrunn ES, Ssentongo AE, et al. Prevalence of HIV in patients hospitalized for COVID-19 and associated mortality outcomes: a systematic review and meta-analysis. Presented at: IDWeek 2020; October 21-25, 2020. Poster 393.

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