Original article
Trends in hospital admissions, re-admissions, and in-hospital mortality among HIV-infected patients between 1993 and 2013: Impact of hepatitis C co-infectionTendencia de las hospitalizaciones, reingresos y mortalidad intrahospitalaria en los pacientes infectados por VIH entre 1993-2013: impacto de la coinfección por el virus de la hepatitis C

https://doi.org/10.1016/j.eimc.2016.07.012Get rights and content

Abstract

Background

New patterns in epidemiological characteristics of people living with HIV infection (PLWH) and the introduction of Highly Active Antiretroviral Therapy (HAART) have changed the profile of hospital admissions in this population. The aim of this study was to evaluate trends in hospital admissions, re-admissions, and mortality rates in HIV patients and to analyze the role of HCV co-infection.

Methods

A retrospective cohort study conducted on all hospital admissions of HIV patients between 1993 and 2013. The study time was divided in two periods (1993–2002 and 2003–2013) to be compared by conducting a comparative cross-sectional analysis.

Results

A total of 22,901 patient-years were included in the analysis, with 6917 hospital admissions, corresponding to 1937 subjects (75% male, mean age 36 ± 11 years, 37% HIV/HCV co-infected patients). The median length of hospital stay was 8 days (5–16), and the 30-day hospital re-admission rate was 20.1%. A significant decrease in hospital admissions related with infectious and psychiatric diseases was observed in the last period (2003–2013), but there was an increase in those related with malignancies, cardiovascular, gastrointestinal, and chronic respiratory diseases. In-hospital mortality remained high (6.8% in the first period vs. 6.3% in the second one), with a progressive increase of non-AIDS-defining illness deaths (37.9% vs. 68.3%, P < .001). The admission rate significantly dropped after 1996 (4.9% yearly), but it was less pronounced in HCV co-infected patients (1.7% yearly).

Conclusions

Hospital admissions due to infectious and psychiatric disorders have decreased, with a significant increase in non-AIDS-defining malignancies, cardiovascular, and chronic respiratory diseases. In-hospital mortality is currently still high, but mainly because of non-AIDS-defining illnesses. HCV co-infection increased the hospital stay and re-admissions during the study period.

Resumen

Introducción

Los cambios en las características epidemiológicas de los pacientes con infección por el VIH, y la introducción del tratamiento antirretroviral de alta eficacia, han modificado el perfil de las hospitalizaciones en esta población. El objetivo del estudio fue evaluar las tendencias en hospitalización, reingreso y mortalidad en pacientes VIH, y analizar el papel de la coinfección por el VHC.

Métodos

Estudio de cohortes retrospectivo, que incluyó todas las hospitalizaciones de pacientes VIH entre 1993-2013. El estudio fue dividido en 2 periodos (1993-2002 y 2003-2013) para ser comparados mediante un análisis transversal.

Resultados

Se analizaron 22.901 pacientes/años, que presentaron 6.917 hospitalizaciones que correspondieron a 1.937 pacientes (75% varones, edad media 36 ± 11 años, 37% coinfectados VIH/VHC). La mediana de estancia hospitalaria fue de 8 días (5-16), y la tasa de reingreso a los 30 días del 20,1%. Se observó un descenso significativo en el segundo periodo (2003-2013) de las hospitalizaciones motivadas por enfermedades infecciosas y trastornos psiquiátricos, y un incremento de aquellas relacionadas con neoplasias, enfermedad cardiovascular, gastrointestinal y enfermedades respiratorias crónicas. La mortalidad intrahospitalaria permanece elevada (6,8% en el primer periodo vs. 6,3% en el segundo), con un aumento progresivo de las muertes por enfermedades no definitorias de sida (37,9 vs. 68,3%; p < 0,001). La tasa de hospitalización disminuyó de manera significativa después de 1996 (4,9% anual), pero este descenso fue menos acusado en los pacientes coinfectados VIH/VHC (1,7% anual).

Conclusiones

Las hospitalizaciones motivadas por enfermedades infecciosas y trastornos psiquiátricos han descendido; por el contrario, se observó un aumento significativo de aquellas relacionadas con neoplasias no definitorias de sida, enfermedad cardiovascular y enfermedades respiratorias crónicas. La mortalidad intrahospitalaria permanece a día de hoy elevada, pero a expensas fundamentalmente de enfermedades no definitorias de sida. La coinfección VIH/VHC incrementó los días de hospitalización y los reingresos durante el periodo de estudio.

Section snippets

Background

Since the introduction of Highly Active Antiretroviral Therapy (HAART) in 1996, the profile of people living with HIV infection (PLWH) has changed significantly; with an appreciable decline of mortality related to AIDS-defining diseases and an improvement in life expectancy. However, the incidence of other comorbidities, mainly cardiovascular diseases and non-AIDS tumors has increased, due to the longer life expectancy, aging and persistent inflammation related to the HIV-infection, even in a

Methods

The Complexo Hospitalario Universitario de A Coruña (CHUAC) is a 1422-bed, full service, 24 h ICU availability, tertiary acute university care hospital, serving in the Northwest of Spain. The influence population in 2013 was 547,776 citizens, and that year reported 40,869 admissions (21% scheduled). The HIV and Hepatitis Viral Unit offers outpatient and inpatient medical care to all PLWH in this reference area, attending more than 1400 PLWH by HIV-trained doctors. PLWH are not attended in other

Demographic characteristics and hospitalization parameters

A total of 2498 PLWH were followed during the period study, contributing to 22,901 patient-years (PY). In the study period 6917 hospital admissions were recorded, corresponding to 1937 subjects. Of them, 75.0% were male, mean age (at first hospitalization) was 36.4 ± 10.6 years, and 37.2% were HIV/HCV coinfected. Among those PLWH hospitalized, 789 (40.7%) have one admission; the median number of admission was 2 (IQR: 1–4). The hospitalization rate showed a reduction from 30.7/100 patients (CI95%:

Discussion

This study evaluates trends in hospitalizations among PLWH in a medical reference area of Northwest Spain. Overall, the hospitalizations rate showed a decline from 31/100 patients in 1993 to 20/100 patients in 2013, but remains higher than in the general population. These results are concordant with other previously published in different countries and different Health Care Systems.6, 21 The joinpoint analysis established a point of change in 1996. This behavior is related with the introduction

Conflicts of interest

All authors declare no conflicts of interest.

Acknowledgements

This work was supported in part by grants from Fondo de Investigación Sanitaria (CPII14/00014, PI10/02166, PI13/02266, CM13/00328), and Fundación Profesor Novoa Santos, A Coruña. We would like to thank Biobank of A Coruña (SERGAS) for providing us the technical, ethical and legal advice necessary for the development of our research.

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    These authors contributed equally in this work.

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