New research was presented at Virtual CROI 2021, the annual Conference on Retroviruses and Opportunistic Infections, from March 6-10. The features below highlight some of the studies that emerged from the conference.
Risk Factors for Increased LOS in PWH Identified
While evidence indicates that hospital length of stay (LOS) is an important indicator of hospital efficiency and severity of illness, LOS can vary by geographic region. To evaluate inpatient LOS in people with HIV (PWH) by diagnostic category and to identify factors associated with increased LOS in PWH, researchers assessed data on all adults receiving longitudinal HIV care at 14 geographically diverse sites. Among nearly 3,200 patients hospitalized during 4,704 person-years of active outpatient care, the overall mean LOS was 6.8 days. Mean LOS was longest for AIDS-defining illness (ADI; 9.3 days), non-AIDS-defining infections (7.4 days), and pulmonary-related issues (7.3 days). CD4 counts of 51-200 (adjusted incidence rate ratio [aIRR, 1.13]) and 50 or lower (aIRR, 1.37) were associated with increased LOS when compared with a CD4 count greater than 350. Medicaid and Medicare were both associated with increased LOS when compared with other healthcare coverage. Age 60 or older (aIRR, 1.17) was associated with increased LOS when compared with age 18-29, as was southern region (aIRR, 1.10) when compared with eastern region, whereas western region was associated with lower LOS (aIRR, 0.87). No associations with LOS were seen for sex, race, or HIV status. “Higher inpatient utilization in patients with ADI and low CD4 highlights the potential importance of early ART initiation to reduce LOS,” write the study authors.
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Hospitalization Causes for PWH
With a lack of recent data to characterize hospitalization trends among people with HIV (PWH), study investigators examined all-cause and cause-specific hospitalization rates among US and Canadian PWH from 2005-2015. Among more than 27,000 patients, 81% were male, 33% Black, 52% men who have sex with men, and 13% with an illicit drug use history. During the studied period, median age among hospitalized PWH increased from 43 to 49, CD4 count increased from 389 cells/µL to 579 cells/µL, and the proportion with HIV RNA less than 400 copies/mL increased from 54% to 86%. Also during the studied period, the annual all-cause hospitalization rate per 100 person-years decreased from 22.8 to 13.5, with a mean annual change of -4%. The most common discharge diagnosis categories were non-AIDS infection (25%), cardiovascular disease (CVD; 10%), liver/gastrointestinal (8%), psychiatric/substance use (8%), non-AIDS cancer (6%), and AIDS-defining illness (ADI; 6%). While crude rates decreased for all categories—with the exception of no change for injury, endocrine, and musculoskeletal—adjusted rates decreased for CVD (-4%) and ADI (-8%) and were stable for other categories.
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Treatment Disparities in PWH Hospitalized With ACS
To test the hypothesis that adult patients with HIV (PWH) admitted with acute coronary syndrome (ACS) are less likely to receive percutaneous coronary intervention and have greater adverse outcomes compared with uninfected patients, researchers compared data for PWH admitted with ACS and those without HIV admitted with ACS between January 2014 and December 2016. PWH were younger (57 vs 67) and had a higher burden of medical comorbidities like diabetes and substance abuse, but rates of ST-elevation myocardial infarction were similar between the groups. In adjusted analysis, PWH were less likely to receive coronary angiogram (31.6% vs 33.4%) or drug-eluting stents (16.5% vs 18.2%). PWH also had a significantly higher inpatient mortality rate (5.5% vs 5.3%), despite having fewer complications, such as acute heart failure (19.9% vs 23.2%), or major bleeding (2.8% vs 3.5%). “Further attention is needed in order to improve the use of guideline-based therapies with the goal of optimizing the care and outcomes among persons living with HIV,” write the study authors.
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Interdisciplinary, Hospital-Based Intervention May Increase MAT for PWID
For a study, investigators tested the hypothesis that the University of Alabama, Birmingham Hospital Intravenous Antibiotics and Addiction Team’s 9-item risk assessment to classify one’s risk for continued IV drug use and inform discharge planning (IVAT) may improve medication-assisted therapy (MAT) prescriptions on discharge—which can help prevent HIV—in hospitalized patients who inject drugs (PWID). Outcomes were compared during periods before and after IVAT initiation. HIV was present in 3% of pre-IVAT patients and 5% of post-IVAT patients, whereas hepatitis C was present in 68% and 80%, respectively. Although the percentage of patients receiving MAT remained at 32% with IVAT, MAT prescriptions increased with IVAT, and there was an increase in those who were deemed “high risk” for continued intravenous drug use (55%).
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ART for HIV-Positive Substance Users While Hospitalized Predicts Tx Engagement
In Project HOPE, the effects of 6 months of patient navigation alone or with contingency management were compared with those of treatment as usual in regard to viral suppression rates at 6 and 12 months post-randomization among substance-using, HIV-positive patients recruited from the hospital, among who ART was initiated at providers’ discretion. For a secondary analysis, researchers examined factors related to ART initiation in the hospital and its association with care engagement and viral suppression. Opioid use (odds ratio [OR], 2.06) and having participated in substance use treatment (OR, 1.87) were associated with greater likelihood of receiving ART in the hospital, with opioid use also associated with higher likelihood of substance treatment (OR, 3.75). At 12-month follow-up, the median number of days before first HIV primary care visit was 29 among those who started ART in the hospital, compared with 54 in those who did not. After controlling for these factors and patient group, no association was seen between starting ART in the hospital and viral suppression at 6 (OR, 1.51) or 12 months (PR, 0.83).
