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Hofmeister MG, Zhong Y, Moorman AC, Teshale EH, Samuel CR, Spradling PR. Regional Differences in Hepatitis C-Related Hospitalization Rates, United States, 2012-2019. Public Health Rep 2024:333549241260252. [PMID: 39057103 DOI: 10.1177/00333549241260252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVES In the United States, hepatitis C is the most commonly reported bloodborne infection. It is a leading cause of liver cancer and death from liver disease and imposes a substantial burden of hospitalization. We sought to describe regional differences in hepatitis C virus (HCV)-related hospitalizations during 2012 through 2019 to guide planning for hepatitis C elimination. METHODS We analyzed discharge data from the National Inpatient Sample for 2012 through 2019. We considered hospitalizations to be HCV-related if (1) hepatitis C was the primary diagnosis or (2) hepatitis C was any secondary diagnosis and the primary diagnosis was a liver disease-related condition. We analyzed demographic and clinical characteristics of HCV-related hospitalizations and modeled the annual percentage change in HCV-related hospitalization rates, nationally and according to the 9 US Census Bureau geographic divisions. RESULTS During 2012-2019, an estimated 553 900 HCV-related hospitalizations occurred in the United States. The highest hospitalization rate (34.7 per 100 000 population) was in the West South Central region, while the lowest (17.6 per 100 000 population) was in the West North Central region. During 2012-2019, annual hospitalization rates decreased in each region, with decreases ranging from 15.3% in the East South Central region to 48.8% in the Pacific region. By type of health insurance, Medicaid had the highest hospitalization rate nationally and in all but 1 geographic region. CONCLUSIONS HCV-related hospitalization rates decreased nationally and in each geographic region during 2012-2019; however, decreases were not uniform. Expanded access to direct-acting antiviral treatment in early-stage hepatitis C would reduce future hospitalizations related to advanced liver disease and interrupt HCV transmission.
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Affiliation(s)
- Megan G Hofmeister
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yuna Zhong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anne C Moorman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina R Samuel
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip R Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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2
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Ng M, Carrieri PM, Awendila L, Socías ME, Knight R, Ti L. Hepatitis C Virus Infection and Hospital-Related Outcomes: A Systematic Review. Can J Gastroenterol Hepatol 2024; 2024:3325609. [PMID: 38487594 PMCID: PMC10940031 DOI: 10.1155/2024/3325609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
Background People living with hepatitis C infection (HCV) have a significant impact on the global healthcare system, with high rates of inpatient service use. Direct-acting antivirals (DAAs) have the potential to alleviate this burden; however, the evidence on the impact of HCV infection and hospital outcomes is undetermined. This systematic review aims to assess this research gap, including how DAAs may modify the relationship between HCV infection and hospital-related outcomes. Methods We searched five databases up to August 2022 to identify relevant studies evaluating the impact of HCV infection on hospital-related outcomes. We created an electronic database of potentially eligible articles, removed duplicates, and then independently screened titles, abstracts, and full-text articles. Results A total of 57 studies were included. Analysis of the included studies found an association between HCV infection and increased number of hospitalizations, length of stay, and readmissions. There was less consistent evidence of a relationship between HCV and in-hospital mortality. Only four studies examined the impact of DAAs, which showed that DAAs were associated with a reduction in hospitalizations and mortality. In the 14 studies available among people living with HIV, HCV coinfection similarly increased hospitalization, but there was less evidence for the other hospital-related outcomes. Conclusions There is good to high-quality evidence that HCV negatively impacts hospital-related outcomes, primarily through increased hospitalizations, length of stay, and readmissions. Given the paucity of studies on the effect of DAAs on hospital outcomes, future research is needed to understand their impact on hospital-related outcomes.
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Affiliation(s)
- Michelle Ng
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
| | - Patrizia Maria Carrieri
- Faculté de Médecine, Aix Marseille Université, 27 bd Jean Moulin 13385, Marseille Cedex 5, France
| | - Lindila Awendila
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, Canada V6Z 1Y6
| | - Maria Eugenia Socías
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, Canada V5Z 1M9
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
- École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, Canada H3N 1X9
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, Canada V5Z 1M9
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3
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Rein SM, Lampe FC, Ingle SM, Sterne JAC, Trickey A, Gill MJ, Papastamopoulos V, Wittkop L, van der Valk M, Kitchen M, Guest JL, Satre DD, Wandeler G, Galindo P, Castilho J, Crane HM, Smith CJ. 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. Lancet Public Health 2023; 8:e776-e787. [PMID: 37777287 PMCID: PMC10851157 DOI: 10.1016/s2468-2667(23)00178-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Understanding demographic disparities in hospitalisation is crucial for the identification of vulnerable populations, interventions, and resource planning. METHODS Data were from the Antiretroviral Therapy Cohort Collaboration (ART-CC) on people living with HIV in Europe and North America, followed up between January, 2007 and December, 2020. We investigated differences in all-cause hospitalisation according to gender and mode of HIV acquisition, ethnicity, and combined geographical origin and ethnicity, in people living with HIV on modern combination antiretroviral therapy (cART). Analyses were performed separately for European and North American cohorts. Hospitalisation rates were assessed using negative binomial multilevel regression, adjusted for age, time since cART intitiaion, and calendar year. FINDINGS Among 23 594 people living with HIV in Europe and 9612 in North America, hospitalisation rates per 100 person-years were 16·2 (95% CI 16·0-16·4) and 13·1 (12·8-13·5). Compared with gay, bisexual, and other men who have sex with men, rates were higher for heterosexual men and women, and much higher for men and women who acquired HIV through injection drug use (adjusted incidence rate ratios ranged from 1·2 to 2·5 in Europe and from 1·2 to 3·3 in North America). In both regions, individuals with geographical origin other than the region of study generally had lower hospitalisation rates compared with those with geographical origin of the study country. In North America, Indigenous people and Black or African American individuals had higher rates than White individuals (adjusted incidence rate ratios 1·9 and 1·2), whereas Asian and Hispanic people living with HIV had somewhat lower rates. In Europe there was a lower rate in Asian individuals compared with White individuals. INTERPRETATION Substantial disparities exist in all-cause hospitalisation between demographic groups of people living with HIV in the current cART era in high-income settings, highlighting the need for targeted support. FUNDING Royal Free Charity and the National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Sophia M Rein
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Institute for Global Health, UCL, London, UK.
| | | | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Vasileios Papastamopoulos
- Department of Internal Medicine and Infectious Diseases, Evaggelismos General Hospital, Athens, Greece
| | - Linda Wittkop
- University of Bordeaux, INSERM, Bordeaux Population Health-U1219, CIC1401-EC, Bordeaux, France; CHU de Bordeaux-Bordeaux University Hospital, Service d'information médicale, INSERM, CIC-EC 1401, Bordeaux, Franc; SISTM, INRIA, University of Bordeaux, Talence, France
| | - Marc van der Valk
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Maria Kitchen
- Department of Dermatology, Venereology, and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jodie L Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Pepa Galindo
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Jessica Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heidi M Crane
- Department of Medicine and Department of Health Services, University of Washington, Seattle, WA, USA
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4
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Chalouni M, Trickey A, Ingle SM, Sepuvelda MA, Gonzalez J, Rauch A, Crane HM, Gill MJ, Rebeiro PF, Rockstroh JK, Franco RA, Touloumi G, Neau D, Laguno M, Rappold M, Smit C, Sterne JAC, Wittkop L. Impact of hepatitis C cure on risk of mortality and morbidity in people with HIV after antiretroviral therapy initiation. AIDS 2023; 37:1573-1581. [PMID: 37199601 DOI: 10.1097/qad.0000000000003594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Hepatitis C virus (HCV) co-infection is associated with increased morbidity and mortality in people with HIV (PWH). Sustained virological response (SVR) decreases the risk of HCV-associated morbidity. We compared mortality, risk of AIDS-defining events, and non-AIDS nonliver (NANL) cancers between HCV-co-infected PWH who reached SVR and mono-infected PWH. DESIGN Adult PWH from 21 cohorts in Europe and North America that collected HCV treatment data were eligible if they were HCV-free at the time of ART initiation. METHODS Up to 10 mono-infected PWH were matched (on age, sex, date of ART start, HIV acquisition route, and being followed at the time of SVR) to each HCV-co-infected PWH who reached SVR. Cox models were used to estimate relative hazards (hazard ratio) of all-cause mortality, AIDS-defining events, and NANL cancers after adjustment. RESULTS Among 62 495 PWH, 2756 acquired HCV, of whom 649 reached SVR. For 582 of these, at least one mono-infected PWH could be matched, producing a total of 5062 mono-infected PWH. The estimated hazard ratios comparing HCV-co-infected PWH who reached SVR with mono-infected PWH were 0.29 [95% confidence interval (CI) 0.12-0.73] for mortality, 0.85 [0.42-1.74] for AIDS-defining events, and 1.21 [0.86-1.72] for NANL cancer. CONCLUSION PWH who reached SVR a short time after HCV acquisition were not at higher risk of overall mortality compared with mono-infected PWH. However, the apparent higher risk of NANL cancers in HCV-co-infected PWH who reached SVR after a DAA-based treatment compared with mono-infected PWH, though compatible with a null association, suggests a need for monitoring of those events following SVR.
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Affiliation(s)
- Mathieu Chalouni
- University Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux
- INRIA SISTM Team, Talence, France
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Suzanne M Ingle
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Juan Gonzalez
- HIV Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Peter F Rebeiro
- Department of Medicine & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Ricardo A Franco
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Giota Touloumi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Didier Neau
- CHU de Bordeaux, Service des Maladies Infectieuses et Tropicales, INSERM, U1219, Pl. Amélie Raba Léon, Bordeaux, France
| | | | - Michaela Rappold
- Department of Dermatology and Venereology, Medical University of Innsbruck
- Austrian HIV Cohort Study, Innsbruck, Austria
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | | | - Linda Wittkop
- University Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux
- INRIA SISTM Team, Talence, France
- CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
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5
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Kibuuka H, Musingye E, Mwesigwa B, Semwogerere M, Iroezindu M, Bahemana E, Maswai J, Owuoth J, Esber A, Dear N, Crowell TA, Polyak CS, Ake JA. Predictors of All-Cause Mortality among People with HIV in a Prospective Cohort Study in East Africa and Nigeria. Clin Infect Dis 2021; 75:657-664. [PMID: 34864933 PMCID: PMC9464064 DOI: 10.1093/cid/ciab995] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background Introduction of antiretroviral therapy (ART) has been associated with a decline in human immunodeficiency virus (HIV)-related mortality, although HIV remains a leading cause of death in sub-Saharan Africa. We describe all-cause mortality and its predictors in people living with HIV (PLWH) in the African Cohort Study (AFRICOS). Methods AFRICOS enrolls participants with or without HIV at 12 sites in Kenya, Uganda, Tanzania, and Nigeria. Evaluations every 6 months include sociobehavioral questionnaires, medical history, physical examination, and laboratory tests. Mortality data are collected from medical records and survivor interviews. Multivariable Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for factors associated with mortality. Results From 2013 through 2020, 2724 PLWH completed at least 1 follow-up visit or experienced death. Of these 58.4% were females, 25.8% were aged ≥ 50 years, and 98.3% were ART-experienced. We observed 11.42 deaths per 1000 person-years (95% CI: 9.53–13.68) with causes ascertained in 54% of participants. Deaths were caused by malignancy (28.1%), infections (29.7%), and other non-HIV related conditions. Predictors of mortality included CD4 ≤ 350 cells/µL (aHR 2.01 [95% CI: 1.31–3.08]), a log10copies/mL increase of viral load (aHR 1.36 [95% CI: 1.22–1.51]), recent fever (aHR 1.85[95% CI: 1.22–2.81]), body mass index < 18.5 kg/m2 (aHR 2.20 [95% CI: 1.44–3.38]), clinical depression (aHR 2.42 [95% CI: 1.40–4.18]), World Health Organization (WHO) stage III (aHR 2.18 [95% CI: 1.31–3.61]), a g/dL increase in hemoglobin (aHR 0.79 [95% CI: .72–.85]), and every year on ART (aHR 0.67 [95% CI: .56–.81]). Conclusions The mortality rate was low in this cohort of mostly virally suppressed PLWH. Patterns of deaths and identified predictors suggest multiple targets for interventions to reduce mortality.
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Affiliation(s)
- Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Ezra Musingye
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Betty Mwesigwa
- Makerere University Walter Reed Project, Kampala, Uganda
| | | | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Abuja, Nigeria
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Mbeya, Tanzania
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Kericho, Kenya
| | - John Owuoth
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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6
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Factors associated with testing for HIV and hepatitis C among behaviorally vulnerable men in Germany: a cross-sectional analysis upon enrollment into an observational cohort. AIDS Res Ther 2021; 18:52. [PMID: 34399787 PMCID: PMC8365908 DOI: 10.1186/s12981-021-00378-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/04/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND HIV and hepatitis C virus (HCV) have shared routes of transmission among men who have sex with men (MSM). Routine testing facilitates early diagnosis and treatment, thereby preventing morbidity and onward transmission. We evaluated factors associated with HIV and HCV testing in a behaviorally vulnerable cohort of predominantly MSM. METHODS From June 2018 through June 2019, the BRAHMS study enrolled adults at ten German outpatient clinics that serve gender and sexual minority populations. Participants completed behavioral questionnaires that captured prior experience with HIV and HCV testing. Multivariable robust Poisson regression was used to evaluate factors potentially associated with testing in the previous 6 months. RESULTS Among 1017 participants with median age 33 (interquartile range 28-39) years, 1001 (98.4%) reported any lifetime history of HIV testing and 787 (77.4%) reported any HCV testing, including 16 (1.6%) known to be living with HCV. Testing within the last 6 months was reported by 921 (90.6%) and 513 (50.4%) for HIV and HCV, respectively. Recent HIV testing was more common among participants with higher education level and recent HCV testing. Recent HCV testing was more common among participants with non-cisgender identity, lifetime history of illicit drug use, hepatitis B immunity or infection, and recent HIV testing. CONCLUSION Prior testing for HIV was common in this cohort, but interventions are needed to improve HCV risk stratification and access to testing. HIV testing infrastructure can be successfully leveraged to support HCV testing, but differentiated preventive care delivery is needed for some vulnerable populations.
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7
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Adeyemi OA, Mitchell A, Shutt A, Crowell TA, Ndembi N, Kokogho A, Ramadhani HO, Robb ML, Baral SD, Ake JA, Charurat ME, Peel S, Nowak RG. Hepatitis B virus infection among men who have sex with men and transgender women living with or at risk for HIV: a cross sectional study in Abuja and Lagos, Nigeria. BMC Infect Dis 2021; 21:654. [PMID: 34229613 PMCID: PMC8259010 DOI: 10.1186/s12879-021-06368-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the development of a safe and efficacious hepatitis B vaccine in 1982, the hepatitis B virus (HBV) remains a public health burden in sub-Saharan Africa. Due to shared risk factors for virus acquisition, men who have sex with men (MSM) and transgender women (TGW) living with HIV are at increased risk of HBV. We estimated the prevalence of HBV and associated factors for MSM and TGW living with or without HIV in Nigeria. METHODS Since March 2013, TRUST/RV368 has recruited MSM and TGW in Abuja and Lagos, Nigeria using respondent driven sampling. Participants with HIV diagnosis, enrollment as of June 2015, and available plasma were selected for a cross-sectional study and retrospectively tested for hepatitis B surface antigen and HBV DNA. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with prevalent HBV infection. RESULTS A total of 717 MSM and TGW had a median age of 25 years (interquartile range [IQR]: 21-27), 5% self-reported HBV vaccination, 61% were living with HIV, 10% had prevalent HBV infection and 6% were HIV-HBV co-infected. HIV mono-infected as compared to HIV-HBV co-infected had a higher median CD4 T cell count [425 (IQR: 284-541) vs. 345 (IQR: 164-363) cells/mm3, p = 0.03] and a lower median HIV RNA viral load [4.2 (IQR: 2.3-4.9) vs. 4.7 (IQR: 3.9-5.4) log10copies/mL, p < 0.01]. The only factor independently associated with HBV was self-report of condomless sex at last anal intercourse (OR: 2.2, 95% CI: 1.3, 3.6). HIV infection was not independently associated with HBV (OR: 1.0, 95% CI: 0.7-1.6). CONCLUSION HBV prevalence was moderately high but did not differ by HIV in this cohort of MSM and TGW. Recent condomless sex was associated with elevated HBV risk, reinforcing the need to increase communication and education on condom use among key populations in Nigeria. Evaluating use of concurrent HIV antiretroviral therapy with anti-HBV activity may confirm the attenuated HBV prevalence for those living with HIV.
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Affiliation(s)
- Olusegun A Adeyemi
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA.,Institute of Human Virology, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Andrew Mitchell
- Institute of Human Virology, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Ashley Shutt
- Institute of Human Virology, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | | | - Afoke Kokogho
- U.S. Army Medical Research Directorate - Africa, Nairobi, Kenya.,HJF Medical Research International, Abuja, Nigeria
| | - Habib O Ramadhani
- Institute of Human Virology, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Merlin L Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Stefan D Baral
- John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Manhattan E Charurat
- Institute of Human Virology, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Sheila Peel
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rebecca G Nowak
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA. .,Institute of Human Virology, University of Maryland, School of Medicine, Baltimore, MD, USA.
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8
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Tunnage J, Yates A, Nwoga C, Sing'oei V, Owuoth J, Polyak CS, Crowell TA. Hepatitis and tuberculosis testing are much less common than HIV testing among adults in Kisumu, Kenya: results from a cross-sectional assessment. BMC Public Health 2021; 21:1143. [PMID: 34130663 PMCID: PMC8204299 DOI: 10.1186/s12889-021-11164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background Kenya has a high burden of HIV, viral hepatitis, and tuberculosis. Screening is necessary for early diagnosis and treatment, which reduces morbidity and mortality across all three illnesses. We evaluated testing uptake for HIV, viral hepatitis, and tuberculosis in Kisumu, Kenya. Methods Cross-sectional data from adults aged 18–35 years who enrolled in a prospective HIV incidence cohort study from February 2017 to May 2018 were analyzed. A questionnaire was administered to each participant at screening for study eligibility to collect behavioral characteristics and to assess prior testing practices. Among participants without a history of previously-diagnosed HIV, multivariable robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV testing in the 12 months prior to enrollment. A hierarchical model was used to test for differential access to testing due to spatial location. Results Of 671 participants, 52 (7.7%) were living with HIV, 308 (45.9%) were female, and the median age was 24 (interquartile range 21–28) years. Among 651 (97.0%) who had ever been tested for HIV, 400 (61.2%) reported HIV testing in the past 6 months, 129 (19.7%) in the past 6–12 months, and 125 (19.1%) more than one year prior to enrollment. Any prior testing for viral hepatitis was reported by 8 (1.2%) participants and for tuberculosis by 51 (7.6%). In unadjusted models, HIV testing in the past year was more common among females (PR 1.08 [95% CI 1.01, 1.17]) and participants with secondary education or higher (PR 1.10 [95% CI 1.02, 1.19]). In the multivariable model, only secondary education or higher was associated with recent HIV testing (adjusted PR 1.10 [95% CI 1.02, 1.20]). Hierarchical models showed no geographic differences in HIV testing across Kisumu subcounties. Conclusions Prior HIV testing was common among study participants and most had been tested within the past year but testing for tuberculosis and viral hepatitis was far less common. HIV testing gaps exist for males and those with lower levels of education. HIV testing infrastructure could be leveraged to increase access to testing for other endemic infectious diseases.
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Affiliation(s)
- Joshua Tunnage
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Adam Yates
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Valentine Sing'oei
- HJF Medical Research International, Kisumu, Kenya.,Army Medical Research Directorate-Africa, Kisumu, Kenya
| | - John Owuoth
- HJF Medical Research International, Kisumu, Kenya.,Army Medical Research Directorate-Africa, Kisumu, Kenya
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
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9
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Rein SM, Lampe FC, Johnson MA, Bhagani S, Miller RF, Chaloner C, Phillips AN, Burns FM, Smith CJ. All-cause hospitalization according to demographic group in people living with HIV in the current antiretroviral therapy era. AIDS 2021; 35:245-255. [PMID: 33170817 PMCID: PMC7810421 DOI: 10.1097/qad.0000000000002750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We investigated differences in all-cause hospitalization between key demographic groups among people with HIV in the UK in the current antiretroviral therapy (ART) era. DESIGN/METHODS We used data from the Royal Free HIV Cohort study between 2007 and 2018. Individuals were classified into five groups: MSM, Black African men who have sex with women (MSW), MSW of other ethnicity, Black African women and women of other ethnicity. We studied hospitalizations during the first year after HIV diagnosis (Analysis-A) separately from those more than one year after diagnosis (Analysis-B). In Analysis-A, time to first hospitalization was assessed using Cox regression adjusted for age and diagnosis date. In Analysis-B, subsequent hospitalization rate was assessed using Poisson regression, accounting for repeated hospitalization within individuals, adjusted for age, calendar year, time since diagnosis. RESULTS The hospitalization rate was 30.7/100 person-years in the first year after diagnosis and 2.7/100 person-years subsequently; 52% and 13% hospitalizations, respectively, were AIDS-related. Compared with MSM, MSW and women were at much higher risk of hospitalization during the first year [aHR (95% confidence interval, 95% CI): 2.7 (1.7-4.3), 3.0 (2.0-4.4), 2.0 (1.3-2.9), 3.0 (2.0-4.5) for Black African MSW; other ethnicity MSW; Black African women; other ethnicity women respectively, Analysis-A] and remained at increased risk subsequently [corresponding aIRR (95% CI): 1.7 (1.2-2.4), 2.1 (1.5-2.8), 1.5 (1.1-1.9), 1.7 (1.2-2.3), Analysis-B]. CONCLUSION In this setting with universal healthcare, substantial variation exists in hospitalization risk across demographic groups, both in early and subsequent periods after HIV diagnosis, highlighting the need for targeted interventions.
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Affiliation(s)
| | | | | | | | - Robert F. Miller
- Institute for Global Health, UCL
- Royal Free Hampstead NHS Trust, London, UK
| | | | | | - Fiona M. Burns
- Institute for Global Health, UCL
- Royal Free Hampstead NHS Trust, London, UK
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10
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Medical Intensive Care Unit Admission Among Patients With and Without HIV, Hepatitis C Virus, and Alcohol-Related Diagnoses in the United States: A National, Retrospective Cohort Study, 1997-2014. J Acquir Immune Defic Syndr 2019; 80:145-151. [PMID: 30422912 DOI: 10.1097/qai.0000000000001904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND HIV, hepatitis C virus (HCV), and alcohol-related diagnoses (ARD) independently contribute increased risk of all-cause hospitalization. We sought to determine annual medical intensive care unit (MICU) admission rates and relative risk of MICU admission between 1997 and 2014 among people with and without HIV, HCV, and ARD, using data from the largest HIV and HCV care provider in the United States. SETTING Veterans Health Administration. METHODS Annual MICU admission rates were calculated among 155,550 patients in the Veterans Aging Cohort Study by HIV, HCV, and ARD status. Adjusted rate ratios and 95% confidence intervals (CIs) were estimated with Poisson regression. Significance of trends in age-adjusted admission rates were tested with generalized linear regression. Models were stratified by calendar period to identify shifts in MICU admission risk over time. RESULTS Compared to HIV-/HCV-/ARD- patients, relative risk of MICU admission decreased among HIV-mono-infected patients from 61% (95% CI: 1.56 to 1.65) in 1997-2009% to 21% (95% CI: 1.16 to 1.27) in 2010-2014, increased among HCV-mono-infected patients from 22% (95% CI: 1.16 to 1.29) in 1997-2009% to 54% (95% CI: 1.43 to 1.67) in 2010-2014, and remained consistent among patients with ARD only at 46% (95% CI: 1.42 to 1.50). MICU admission rates decreased by 48% among HCV-uninfected patients (P-trend <0.0001) but did not change among HCV+ patients (P-trend = 0.34). CONCLUSION HCV infection and ARD remain key contributors to MICU admission risk. The impact of each of these conditions could be mitigated with combination of treatment of HIV, HCV, and interventions targeting unhealthy alcohol use.
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11
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Pham T, Rathbun RC, Keast S, Nesser N, Farmer K, Skrepnek G. National estimates of case-mix, mortality, and economic outcomes among inpatient HIV/AIDS mono-infection and hepatitis C co-infection cases in the US. J Eval Clin Pract 2019; 25:806-821. [PMID: 30485617 DOI: 10.1111/jep.13076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES To assess inpatient clinical and economic outcomes for AIDS/HIV and Hepatitis C (HCV) co-infection in the United States from 2003 to 2014. METHOD This historical cohort study utilized nationally representative hospital discharge data to investigate inpatient mortality, length of stay (LoS), and inflation-adjusted charges among adults (≥18 years). Outcomes were analysed via multivariable generalized linear models according to demographics, hospital and clinical characteristics, and AIDS/HIV or HCV sequelae. RESULTS Overall, 17.8% of the 2.75 million estimated AIDS/HIV inpatient cases involved HCV from 2003 to 2014, averaging 48.5 ± 9.0 years of age and 68.0% being male. Advanced sequalae of AIDS and HCV incurred a LoS of 10.3 ± 11.9 days, charges of $88 789 ± 131 787, and a 16.9% mortality. Many cases involved noncompliance, tobacco use disorders, and substance abuse. Although mortality decreased over time, multivariable analyses indicated that poorer outcomes were generally associated with more advanced clinical conditions and AIDS-associated sequalae, although mixed results were observed for specific manifestations of HCV. Rural residence was independently associated with a 3.26 times higher adjusted odds of mortality from 2009 to 2014 for HIV/HCV co-infection (P < 0.001), although not for AIDS/HCV (OR = 1.38, P = 0.166). CONCLUSION Given the systemic nature and modifiable risks inherent within coinfection, more proactive screening and intervention appear warranted, particularly within rural areas.
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Affiliation(s)
- Timothy Pham
- The University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, USA
| | - R Chris Rathbun
- The University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, USA
| | - Shellie Keast
- The University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, USA
| | - Nancy Nesser
- Oklahoma Health Care Authority, Oklahoma City, USA
| | - Kevin Farmer
- The University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, USA
| | - Grant Skrepnek
- The University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, USA
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12
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Cammarota S, Citarella A, Manzoli L, Flacco ME, Parruti G. Impact of comorbidity on the risk and cost of hospitalization in HIV-infected patients: real-world data from Abruzzo Region. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:389-398. [PMID: 30087571 PMCID: PMC6061204 DOI: 10.2147/ceor.s162625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Due to the success of antiretroviral therapy, human immunodeficiency virus (HIV) infection has been transformed into a lifelong condition. In Italy, little is known about the impact of comorbidities (CMs) on the risk of hospitalization and related costs for people who live with HIV (PWLHIV). The objective of the study was to quantify the risk of hospitalization and costs associated with CMs in an Italian cohort of PWLHIV. Methods The study population included subjects aged ≥18 years with HIV infection, identified in the Abruzzo’s hospital discharge database among files stored from 2004 until 2013 and then followed up until December 2015. Patients’ CMs (Charlson Comorbidity Index [CCI)] were extracted from International Classification of Diseases, Ninth Revision, Clinical Modification codes in the hospital discharge abstracts. Poisson regression was used to compare the incidence rate of hospital admissions in patients with and without each CM class. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were adjusted for age, sex and the other CMs. A generalized linear model under gamma distribution was used to estimate adjusted mean hospital costs. Costs were derived from official Italian Diagnosis-related group (DRG) based reimbursements. Results Among 1,026 HIV patients identified (mean age 47 years), 30% had at least one CM and 14.5% underwent hospital admission during the follow-up period. The risk of acute hospitalization significantly increased among patients with hepatitis C virus (HCV) coinfection (adjusted IRR 1.98; 95% CI: 1.59–2.47), renal (adjusted IRR 2.27; 95% CI: 1.45–3.56), liver (adjusted IRR 2.21; 1.57–3.13) and chronic pulmonary CMs (adjusted IRR 2.31; 1.63–3.32). Adjusted mean hospital costs were €2,494 in patients without CMs and €4,422 and €9,734 in those with CCI=1 or CCI ≥2, respectively. Conclusion The presence of renal, liver and chronic pulmonary CMs, as well as HCV coinfection doubled the risk of hospitalization in the PWLHIV cohort. A CCI ≥2 is associated with a fourfold increase in hospitalization costs. Our study provides new evidence that CMs in PWLHIV increase the risk of hospitalization and local health service facilities.
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Affiliation(s)
- Simona Cammarota
- LinkHealth s.r.l., Health Economics, Outcomes & Epidemiology, Naples, Italy
| | - Anna Citarella
- LinkHealth s.r.l., Health Economics, Outcomes & Epidemiology, Naples, Italy
| | - Lamberto Manzoli
- Department of Medicine Sciences, University of Ferrara, Ferrara, Italy.,Regional Healthcare Agency of Abruzzo, Pescara, Italy
| | | | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy,
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13
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Gallant J, Hsue P, Budd D, Meyer N. Healthcare utilization and direct costs of non-infectious comorbidities in HIV-infected patients in the USA. Curr Med Res Opin 2018; 34:13-23. [PMID: 28933204 DOI: 10.1080/03007995.2017.1383889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To estimate the incremental healthcare utilization and costs associated with common non-infectious comorbid conditions among commercially and Medicaid-insured HIV-infected patients in the US. METHODS US administrative claims were used to select adult HIV patients with chronic kidney disease (CKD), cardiovascular disease (CVD) events, or fracture/osteoporosis, three common comorbidities that have been associated with HIV and HIV treatment, between 1 January 2004 and 30 June 2013. Propensity score matched controls with no CKD, no CVD events, and no fracture/osteoporosis were identified for comparison. All-cause healthcare utilization and costs were reported as per patient per month (PPPM). RESULTS The commercial cohort comprised 381 CKD patients, 624 patients with CVD events, and 774 fracture/osteoporosis patients, and 1013, 1710, and 2081 matched controls, respectively; while the Medicaid HIV cohort comprised 207 CKD and 271 CVD cases, and 516 and 735 matched controls, respectively. There was insufficient Medicaid data for fracture analyses. Across both payers, HIV patients with CKD or CVD events had significantly higher healthcare utilization and costs than controls. The average incremental PPPM costs in HIV patients with CKD were $1403 in the commercial cohort and $3051 in the Medicaid cohort. In those with CVD events, the incremental costs were $2655 (commercial) and $4959 (Medicaid) for HIV patients compared to controls (p < .001). CONCLUSIONS The results suggested a considerable increase in healthcare utilization and costs associated with CKD, CVD and fracture/osteoporosis comorbidities among HIV patients in the past decade. Because these conditions have been associated with treatment, it is critical to consider their impact on costs and outcomes when optimizing patient care.
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Affiliation(s)
| | | | - David Budd
- c Gilead Sciences , Foster City , CA , USA
| | - Nicole Meyer
- d Truven Health Analytics, an IBM Company , Cambridge , MA , USA
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14
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Seng R, Mutuon P, Riou J, Duvivier C, Weiss L, Lelievre JD, Meyer L, Vittecoq D, Zak Dit Zbar O, Frenkiel J, Frank-Soltysiak M, Boue F, Rapp C, Sobel A, Brucker G, Goujard C, Salmon D. Hospitalization of HIV positive patients: Significant demand affecting all hospital sectors. Rev Epidemiol Sante Publique 2017; 66:7-17. [PMID: 29233572 DOI: 10.1016/j.respe.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/16/2017] [Accepted: 08/30/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In a context of the evolution of severe morbidities in patients living with HIV (PLWH), the aim of this study was to describe reasons for hospitalization and the mode of care for the patients requiring hospitalization. METHODS All admissions (≥24h) of PLWH to 10 hospitals in the south of Paris (COREVIH Ile-de-France Sud) between 1/1/2011 and 12/31/2011 were identified. The hospital database and the file of patients followed in the HIV referral department of each hospital were matched. Detailed clinical and biological data were collected, by returning to the individual medical records, for a random sample (65% of hospitalized patients). RESULTS A total of 3013 hospitalizations (1489 patients) were recorded in 2011. The estimated rate of hospitalized patients was about 8% among the 10105 PLWH routinely managed in COREVIH Ile-de-France Sud in 2011. The majority (58.5%) of these hospitalizations occurred in a unit other than the HIV referral unit. Non-AIDS-defining infections were the main reason for admission (16.4%), followed by HIV-related diseases (15.6%), hepatic/gastrointestinal diseases (12.0%), and cardiovascular diseases (10.3%). The median length of stay was 5 days overall (IQR: 2-11), it was longer among patients admitted to a referral HIV care unit than to another ward. HIV infection had been diagnosed >10 years previously in 61.4% of these hospitalized patients. They often had associated comorbidities (coinfection HCV/HVB 40.5%, smoking 45.8%; hypertension 33.4%, dyslipidemia 28.8%, diabetes 14.8%). Subjects over 60 years old accounted for 15% of hospitalized patients, most of them were virologically controlled under HIV treatment, and cardiovascular diseases were their leading reason for admission. CONCLUSION Needs for hospitalization among PLWH remain important, with a wide variety in causes of admission, involving all hospital departments. It is essential to prevent comorbidities to reduce these hospitalizations, and to maintain a link between the management of PLWH, that becomes rightly, increasing ambulatory, and recourse to specialized inpatient services.
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Affiliation(s)
- R Seng
- CESP INSERM, Paris-Sud-University, 94276 Le-Kremlin-Bicêtre cedex, France; Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France.
| | - P Mutuon
- Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - J Riou
- Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - C Duvivier
- Paris-Descartes University, Sorbonne-Paris-Cité, 75006 Paris, France; Department of Infectious Diseases, Necker-Pasteur Infectious Diseases Center, AP-HP Necker hospital, 75015 Paris, France
| | - L Weiss
- Paris-Descartes University, Sorbonne-Paris-Cité, 75006 Paris, France; Department of Clinical Immunology, AP-HP Georges-Pompidou hospital, 75015 Paris, France
| | - J D Lelievre
- Department of Clinical Immunology and Infectious Diseases, AP-HP Henri-Mondor hospital, 94010 Creteil, France
| | - L Meyer
- CESP INSERM, Paris-Sud-University, 94276 Le-Kremlin-Bicêtre cedex, France; Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - D Vittecoq
- Department of Infectious and Tropical Diseases, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - O Zak Dit Zbar
- Department of Infectious Diseases, Cognacq-Jay hospital, 75015 Paris, France
| | - J Frenkiel
- Unité d'information médicale, AP-HP Cochin hospital, 75014 Paris, France
| | - M Frank-Soltysiak
- Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - F Boue
- Department of Internal Medicine, AP-HP Antoine-Beclere hospital, 92140 Clamart, France
| | - C Rapp
- Department of Infectious and Tropical Diseases, Hopital d'Instruction des Armées Bégin, 94160 Saint-Mandé, France
| | - A Sobel
- Department of Infectious Diseases and Immunology, AP-HP Hotel-Dieu hospital, 75004 Paris, France
| | - G Brucker
- Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - C Goujard
- CESP INSERM, Paris-Sud-University, 94276 Le-Kremlin-Bicêtre cedex, France; Department of Internal Medicine, AP-HP Bicetre hospital, 94276 Le Kremlin-Bicêtre cedex, France
| | - D Salmon
- Paris-Descartes University, Sorbonne-Paris-Cité, 75006 Paris, France; Department of Internal Medicine and Infectious Diseases, Diagnosis Center, AP-HP Hotel Dieu hospital, 75004 Paris, France
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15
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Singh KP, Crane M, Audsley J, Avihingsanon A, Sasadeusz J, Lewin SR. HIV-hepatitis B virus coinfection: epidemiology, pathogenesis, and treatment. AIDS 2017; 31:2035-2052. [PMID: 28692539 PMCID: PMC5661989 DOI: 10.1097/qad.0000000000001574] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
: HIV infection has a significant impact on the natural history of chronic hepatitis B virus (HBV) infection, with increased levels of HBV DNA, accelerated progression of liver disease and increased liver-associated mortality compared with HBV monoinfection. Widespread uptake and early initiation of HBV-active antiretroviral therapy has substantially improved the natural history of HIV-HBV coinfection but the prevalence of liver disease remains elevated in this population. In this paper, we review recent studies examining the natural history and pathogenesis of liver disease and seroconversion in HIV-HBV coinfection in the era of HBV-active antiretroviral therapy and the effects of HIV directly on liver disease. We also review novel therapeutics for the management of HBV with a particular emphasis on clinical strategies being developed for an HBV cure and an HIV cure and their impact on HIV-HBV coinfected individuals.
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Affiliation(s)
- Kasha P Singh
- aThe Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital bVictorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity cDepartment of Infectious Diseases, Alfred Hospital and Monash University, Melbourne Australia dThai Red Cross AIDS Research Center and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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16
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Saidakova EV, Shmagel KV, Korolevskaya LB, Shmagel NG, Chereshnev VA. CD8 + T cell expansion in HIV/HCV coinfection is associated with systemic inflammation. DOKLADY BIOLOGICAL SCIENCES : PROCEEDINGS OF THE ACADEMY OF SCIENCES OF THE USSR, BIOLOGICAL SCIENCES SECTIONS 2017; 474:126-128. [PMID: 28702728 DOI: 10.1134/s0012496617030024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Indexed: 11/23/2022]
Abstract
High prevalence of non-AIDS-defining illnesses in treated HIV-infected patients is associated with increased peripheral CD8+ T cell counts. Hepatitis C virus (HCV) coinfection is an additional risk factor for the development of non-AIDS events. We found that, in HIV/HCV coinfection, the increased proportion of CD8+ T lymphocytes is due to the effector memory and terminal effector T cells gain. Moreover, in these patients, the accumulation of highly differentiated forms of CD8+ T lymphocytes was associated with increased concentrations of inflammatory indices.
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Affiliation(s)
- E V Saidakova
- Perm State University, Perm, Russia. .,Institute of Ecology and Genetics of Microorganisms, Ural Branch of the Russian Academy of Sciences, Perm, Russia.
| | - K V Shmagel
- Perm State University, Perm, Russia.,Institute of Ecology and Genetics of Microorganisms, Ural Branch of the Russian Academy of Sciences, Perm, Russia
| | - L B Korolevskaya
- Perm State University, Perm, Russia.,Institute of Ecology and Genetics of Microorganisms, Ural Branch of the Russian Academy of Sciences, Perm, Russia
| | - N G Shmagel
- Perm State University, Perm, Russia.,Perm Regional Center for Prevention and Control of AIDS and Infectious Diseases, Perm, Russia
| | - V A Chereshnev
- Perm State University, Perm, Russia.,Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
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17
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Stafford KA, Rikhtegaran Tehrani Z, Saadat S, Ebadi M, Redfield RR, Sajadi MM. Long-term follow-up of elite controllers: Higher risk of complications with HCV coinfection, no association with HIV disease progression. Medicine (Baltimore) 2017; 96:e7348. [PMID: 28658155 PMCID: PMC5500077 DOI: 10.1097/md.0000000000007348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
To estimate the effect of hepatitis C virus (HCV) coinfection on the development of complications and progression of human immunodeficiency virus (HIV) disease among HIV-infected elite controllers.Single-center retrospective cohort. Kaplan-Meier methods, prevalence ratios, and Cox proportional-hazards models were used.In all, 55 HIV-infected elite controllers were included in this study. Among them, 45% were HIV/HCV coinfected and 55% were HIV mono-infected. Median follow-up time for the cohort was 11 years. Twenty-five patients experienced a complication and 16 lost elite controller status during the study period. HCV coinfected patients were 4.78 times (95% confidence interval 1.50-15.28) more likely to develop complications compared with HIV mono-infected patients. There was no association between HCV coinfection status and loss of elite control (hazard ratio 0.75, 95% confidence interval 0.27-2.06).Hepatitis C virus coinfection was significantly associated with the risk of complications even after controlling for sex, injecting drug use, and older age. HCV coinfected patients had higher levels of cellular activation while also having similar levels of lipopolysaccharide and soluble CD14. HCV coinfection was not associated with loss of elite controller status. Taken together, this suggests that HCV coinfection does not directly affect HIV replication dynamics or natural history, but that it may act synergistically with HIV to produce a greater number of associated complications. Continued follow-up will be needed to determine whether HCV cure through the use of direct-acting antivirals among HIV/HCV coinfected elite controllers will make the risk for complications among these patients similar to their HIV mono-infected counterparts.
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Affiliation(s)
- Kristen A. Stafford
- Institute of Human Virology
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | | | - Saman Saadat
- Institute of Human Virology
- Hamadan University of Medical Sciences, Hamedan, Hamadan Province, Iran
| | | | | | - Mohammad M. Sajadi
- Institute of Human Virology
- Department of Medicine, Baltimore VA Medical Center, Baltimore, MD
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18
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Rajbhandari R, Jun T, Khalili H, Chung RT, Ananthakrishnan AN. HBV/HIV coinfection is associated with poorer outcomes in hospitalized patients with HBV or HIV. J Viral Hepat 2016; 23:820-9. [PMID: 27291562 PMCID: PMC5028254 DOI: 10.1111/jvh.12555] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/03/2016] [Indexed: 12/22/2022]
Abstract
We examined the impact of HBV/HIV coinfection on outcomes in hospitalized patients compared to those with HBV or HIV monoinfection. Using the 2011 US Nationwide Inpatient Sample, we identified patients who had been hospitalized with HBV or HIV monoinfection or HBV/HIV coinfection using ICD-9-CM codes. We compared liver-related admissions between the three groups. Multivariable logistic regression was performed to identify independent predictors of in-hospital mortality, length of stay and total charges. A total of 72 584 discharges with HBV monoinfection, 133 880 discharges with HIV monoinfection and 8156 discharges with HBV/HIV coinfection were included. HBV/HIV coinfection was associated with higher mortality compared to HBV monoinfection (OR 1.67, 95% CI 1.30-2.15) but not when compared to HIV monoinfection (OR 1.22, 95% CI 0.96-1.54). However, the presence of HBV along with cirrhosis or complications of portal hypertension was associated with three times greater in-hospital mortality in patients with HIV compared to those without these complications (OR 3.00, 95% CI 1.80-5.02). Length of stay and total hospitalization charges were greater in the HBV-/HIV-coinfected group compared to the HBV monoinfection group (+1.53 days, P < 0.001; $17595, P < 0.001) and the HIV monoinfection group (+0.62 days, P = 0.034; $8840, P = 0.005). In conclusion, HBV/HIV coinfection is a risk factor for in-hospital mortality, particularly in liver-related admissions, compared to HBV monoinfection. Overall healthcare utilization from HBV/HIV coinfection is also higher than for either infection alone and higher than the national average for all hospitalizations, thus emphasizing the healthcare burden from these illnesses.
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Affiliation(s)
- Ruma Rajbhandari
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Massachusetts General Hospital, Boston, MA, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Tomi Jun
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Hamed Khalili
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Massachusetts General Hospital, Boston, MA, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Raymond T. Chung
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Massachusetts General Hospital, Boston, MA, Department of Medicine, Massachusetts General Hospital, Boston, MA,Corresponding authors,
| | - Ashwin N Ananthakrishnan
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Massachusetts General Hospital, Boston, MA, Department of Medicine, Massachusetts General Hospital, Boston, MA,Corresponding authors,
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19
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Meijide H, Mena Á, Rodríguez-Osorio I, Pértega S, Castro-Iglesias Á, Rodríguez-Martínez G, Pedreira J, Poveda E. Trends in hospital admissions, re-admissions, and in-hospital mortality among HIV-infected patients between 1993 and 2013: Impact of hepatitis C co-infection. Enferm Infecc Microbiol Clin 2016; 35:20-26. [PMID: 27609631 DOI: 10.1016/j.eimc.2016.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 02/08/2023]
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.
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Affiliation(s)
- Héctor Meijide
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain; Servicio de Medicina Interna, Hospital Quiron, A Coruña, Spain
| | - Álvaro Mena
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain.
| | - Iria Rodríguez-Osorio
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
| | - Sonia Pértega
- Unidad de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
| | - Ángeles Castro-Iglesias
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
| | - Guillermo Rodríguez-Martínez
- Unidad de Admisión y Documentación Clínica, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, A Coruña, Spain
| | - José Pedreira
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
| | - Eva Poveda
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
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20
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Montes-Escalante I, Monje-Agudo P, Calvo-Cidoncha E, Almeida-González CV, Morillo-Verdugo R. Design and validation of a predictive model for 1-year hospital admission in HIV patients on antiretroviral treatment. Eur J Hosp Pharm 2016; 23:224-227. [PMID: 31156853 DOI: 10.1136/ejhpharm-2015-000788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/20/2015] [Accepted: 11/30/2015] [Indexed: 11/03/2022] Open
Abstract
Objectives To develop and validate a model for predicting the risk of hospital admission within 1 year in the HIV population under antiretroviral treatment. Methods We conducted a retrospective observational study. Patients receiving antiretroviral treatment for at least 1 year who were followed by the pharmacy service in a Spanish-speaking hospital between January 2008 and December 2012 were included. Demographics, and clinical and pharmacotherapy variables, were included in the model design. To find prognostic factors for hospital admission a multivariate logistic regression model was created after performing a univariate analysis. Model validity was determined by the shrinkage method and the model discrimination by Harrell's C-index. Results 442 patients were included in the study. The variables 'CD4 count <200 (cells/µL)', 'drug/alcohol use', 'detectable viral load (>50 copies/mL)', 'number of previous admissions', and 'number of drugs different from antiretroviral treatment' were the independent predictors of risk of hospital admission. Probabilities predicted by the model showed an R2=0.98 for the development sample and an R2=0.86 for the validation sample. The Harrell's C index for the development and validation data were 0.82 (95% CI 0.77 to 0.87) and 0.80 (95% CI 0.73 to 0.88), respectively. Conclusions The model developed in this study may be useful in daily practice for identifying HIV patients at high risk of 1-year hospital admission.
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Prevalence of hepatitis B and C viruses in HIV-positive patients in China: a cross-sectional study. J Int AIDS Soc 2016; 19:20659. [PMID: 26979535 PMCID: PMC4793284 DOI: 10.7448/ias.19.1.20659] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/06/2016] [Accepted: 02/16/2016] [Indexed: 12/26/2022] Open
Abstract
Introduction Liver disease related to hepatitis B (HBV) and hepatitis C (HCV) may temper the success of antiretroviral therapy (ART) in China. Limited data exist on their prevalence in HIV-positive Chinese. A multi-centre, cross-sectional study was carried out to determine the prevalence and disease characteristics of HBV and HCV co-infection in HIV-positive patients across 12 provinces. Methods HIV-positive ART-naïve patients were recruited from two parent cohorts established during November 2008–January 2010 and August 2012–September 2014. Hepatitis B surface antigen (HBsAg), hepatitis B e antigen and HCV antibody (anti-HCV) status were retrieved from parent databases at the visit prior to ART initiation. HBV DNA was then determined in HBsAg+ patients. HCV RNA was quantified in anti-HCV+ patients. Aspartate aminotransferase-to-platelet ratio index (APRI) and the fibrosis-4 (FIB4) were calculated. Chi-square test, Kruskal–Wallis test and logistic regression were used for statistical analysis, as appropriate. Results Of 1944 HIV-positive patients, 186 (9.5%) were HIV–HBV co-infected and 161 (8.3%) were HIV–HCV co-infected. The highest HIV–HBV prevalence (14.5%) was in Eastern China while the highest HIV–HCV prevalence was in the Central region (28.2%). HIV–HBV patients had lower median CD4 + T cell count (205 cells/μL) than either HIV monoinfected (242 cells/μL, P=0.01) or HIV–HCV patients (274 cells/μL, P=0.001). Moderate-to-significant liver disease was present in >65% of the HIV–HCV, ~35% of the HIV–HBV and ~20% of the HIV monoinfected patients. Independent associations with moderate-to-significant liver disease based on APRI included HBV (Odds ratio, OR 2.37, P < 0.001), HCV (OR 9.64, P<0.001), CD4 count≤200 cells/μL (OR 2.55, P<0.001) and age ≥30 years (OR 1.80, P=0.001). Conclusions HBV and HCV prevalence is high in HIV-positive Chinese and differs by geographic region. HBV and HCV co-infection and HIV monoinfection are risks for moderate-to-significant liver disease. Only HIV–HBV is associated with greater HIV-related immunosuppression. Incorporating screening and management of hepatitis virus infections into Chinese HIV programmes is needed.
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Crowell TA, Ganesan A, Berry SA, Deiss RG, Agan BK, Okulicz JF. Hospitalizations among HIV controllers and persons with medically controlled HIV in the U.S. Military HIV Natural History Study. J Int AIDS Soc 2016; 19:20524. [PMID: 26955965 PMCID: PMC4783305 DOI: 10.7448/ias.19.1.20524] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/17/2015] [Accepted: 01/28/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION HIV controllers (HICs) experience relatively low-level viraemia and CD4 preservation without antiretroviral therapy (ART), but also immune activation that may predispose to adverse clinical events such as cardiovascular disease and hospitalization. The objective of this study was to characterize the rates and reasons for hospitalization among HICs and persons with medically controlled HIV. METHODS Subjects with consistently well-controlled HIV were identified in the U.S. Military HIV Natural History Study. ART prescription and HIV-1 RNA data were used to categorize subjects as HICs or medically controlled as defined by ≥ 3 HIV-1 RNA measurements ≤ 2000 or ≤ 400 copies/mL, respectively, representing the majority of measurements spanning ≥ 12 months. Hospitalizations were tallied and assigned diagnostic categories. All-cause hospitalization rates were compared between groups using negative binomial regression. RESULTS AND DISCUSSION Of 3106 subjects followed from 2000 to 2013, 221 were HICs, including 33 elite (1.1%) and 188 viraemic (6.0%) controllers, who contributed 882 person-years (PY) of observation time. An additional 870 subjects with medically controlled HIV contributed 4217 PY. Mean hospitalization rates were 9.4/100 PY among HICs and 8.8/100 PY among medically controlled subjects. Non-AIDS-defining infections were the most common reason for hospitalization (2.95/100 PY and 2.70/100 PY, respectively) and rates of cardiovascular hospitalization were similar in both groups (0.45/100 PY and 0.76/100 PY). There was no difference in hospitalization rate for HICs compared with subjects with medically controlled HIV (adjusted incidence rate ratio 1.15 [95% confidence interval 0.80 to 1.65]). CONCLUSIONS All-cause and cardiovascular hospitalization rates did not differ between HICs and persons with medically controlled HIV. Non-AIDS defining infections were common in this young, healthy, predominantly male cohort of military personnel and beneficiaries.
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Affiliation(s)
- Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA;
| | - Anuradha Ganesan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Stephen A Berry
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert G Deiss
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, CA, USA
| | - Brian K Agan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason F Okulicz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Infectious Disease Service, San Antonio Military Medical Center, San Antonio, TX, USA;
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Dominguez-Molina B, Leon A, Rodriguez C, Benito JM, Lopez-Galindez C, Garcia F, Del Romero J, Gutierrez F, Viciana P, Alcami J, Leal M, Ruiz-Mateos E. Analysis of Non-AIDS-Defining Events in HIV Controllers. Clin Infect Dis 2016; 62:1304-1309. [PMID: 26936669 DOI: 10.1093/cid/ciw120] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/17/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) controllers have the striking ability to maintain viremia at extremely low or undetectable levels without antiretroviral treatment. Even though these patients have been widely studied, information about clinical outcomes, especially concerning to non-AIDS-defining events (nADEs), is scarce. We have analyzed the frequency and rate of nADEs and their associated factors in a large multicenter HIV controller cohort. METHODS Data on nADEs were recorded for 320 HIV controllers within the multicenter Spanish AIDS Research Network HIV Controllers Cohort (ECRIS). Percentages and crude incidence rates (CIRs) per 100 person-years of follow-up (PYFU) were calculated for the entire follow-up period and for 2 separate periods: the period under control and the period after loss of control. These rates were compared with those for 632 noncontrollers. Demographic and immunological data collected from the controllers were included in a multivariate model to assess factors that were independently associated with nADEs in HIV controllers. RESULTS HIV controllers experience nADEs, albeit at lower rates than patients who do not spontaneously control the virus (1.252 [95% confidence interval {CI}, .974-1.586] per 100 PYFU and 2.481 [95% CI, 2.153-2.845] per 100 PYFU, respectively; P < .001). Hepatitis C virus (HCV) coinfection was the main factor associated with nADEs in all of the studied periods. Although hepatic events were the most prevalent, they represented only approximately 30% of the total events. CIRs of cardiovascular events increased in the post-loss-of-control period. CONCLUSIONS HCV/HIV coinfection was the main factor associated with hepatic and extrahepatic nADEs in HIV controllers. The eradication of HCV infection may ameliorate the presence of comorbidities in these patients.
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Affiliation(s)
- Beatriz Dominguez-Molina
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital
| | - Agathe Leon
- Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona
| | - Carmen Rodriguez
- Centro Sanitario Sandoval, Instituto de Investigacion Sanitaria San Carlos (IdISSC)
| | - Jose M Benito
- Instituto de Investigacion Sanitaria-Fundacion Jimenez Díaz (IIS-FJD), Universidad Autonoma de Madrid (UAM)
| | | | - Felipe Garcia
- Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona
| | - Jorge Del Romero
- Centro Sanitario Sandoval, Instituto de Investigacion Sanitaria San Carlos (IdISSC)
| | - Felix Gutierrez
- Hospital General de Elche and Universidad Miguel Hernández, Alicante
| | - Pompeyo Viciana
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital
| | - Jose Alcami
- AIDS Immunopathology Unit, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Manuel Leal
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital
| | - Ezequiel Ruiz-Mateos
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital
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Walsh N, Durier N, Khwairakpam G, Sohn AH, Lo YR. The hepatitis C treatment revolution: how to avoid Asia missing out. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)30924-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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25
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Walsh N, Durier N, Khwairakpam G, Sohn AH, Lo YR. The hepatitis C treatment revolution: how to avoid Asia missing out. J Virus Erad 2015; 1:272-5. [PMID: 27482424 PMCID: PMC4946660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
The Asia-Pacific region bears a high burden of hepatitis C virus (HCV) infections and the largest number of global deaths. Populations most at risk of infection and disease progression include people who inject drugs and those living with HIV. HCV treatment options have rapidly expanded in the past few years through the development of direct-acting antiviral (DAA) medicines, which can cure HCV in over 95% of cases, but are prohibitively expensive. While price is the major barrier to treatment access, voluntary licensing has resulted in limited availability of one DAA (sofosbuvir) through generic manufacturers in India. Regulatory barriers, such as the need for domestic clinical trials, cause further delays in local medicines approvals and access. Intensive advocacy by civil society in combination with mobilisation of global resources for HIV treatment were critical to achieving price reductions in HIV medicines in the early 2000s. While the current global economic situation is less conducive to substantial funding support for HCV treatment, community advocates are building awareness of the growing opportunities for HCV cure. Key immediate steps include the inclusion of DAAs in domestic essential medicines lists, as the World Health Organization has already done for globally, and fast-tracking domestic drug approvals to facilitate government-level price negotiations with originator and generic pharmaceutical companies. Urgent action by a broad range of stakeholders is needed to facilitate access to HCV treatment in order to ensure that the millions of people living with hepatitis C in the Asia-Pacific will not miss out on these life-saving treatments.
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Affiliation(s)
- Nick Walsh
- HIV, Hepatitis and STIs Unit, Division of Communicable Diseases,
World Health Organization Regional Office for the Western Pacific,
Manila,
Philippines
| | - Nicolas Durier
- TREAT Asia/amfAR, Foundation for AIDS Research,
Bangkok,
Thailand
| | | | - Annette H Sohn
- TREAT Asia/amfAR, Foundation for AIDS Research,
Bangkok,
Thailand
| | - Ying-Ru Lo
- HIV, Hepatitis and STIs Unit, Division of Communicable Diseases,
World Health Organization Regional Office for the Western Pacific,
Manila,
Philippines
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Karageorgopoulos DE, Allen J, Bhagani S. Hepatitis C in human immunodeficiency virus co-infected individuals: Is this still a "special population"? World J Hepatol 2015; 7:1936-52. [PMID: 26244068 PMCID: PMC4517153 DOI: 10.4254/wjh.v7.i15.1936] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/24/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023] Open
Abstract
A substantial proportion of individuals with chronic hepatitis C virus (HCV) are co-infected with human immunodeficiency virus (HIV). Co-infected individuals are traditionally considered as one of the "special populations" amongst those with chronic HCV, mainly because of faster progression to end-stage liver disease and suboptimal responses to treatment with pegylated interferon alpha and ribavirin, the benefits of which are often outweighed by toxicity. The advent of the newer direct acting antivirals (DAAs) has given hope that the majority of co-infected individuals can clear HCV. However the "special population" designation may prove an obstacle for those with co-infection to gain access to the new agents, in terms of requirement for separate pre-licensing clinical trials and extensive drug-drug interaction studies. We review the global epidemiology, natural history and pathogenesis of chronic hepatitis C in HIV co-infection. The accelerated course of chronic hepatitis C in HIV co-infection is not adequately offset by successful combination antiretroviral therapy. We also review the treatment trials of chronic hepatitis C in HIV co-infected individuals with DAAs and compare them to trials in the HCV mono-infected. There is convincing evidence that HIV co-infection no longer diminishes the response to treatment against HCV in the new era of DAA-based therapy. The management of HCV co-infection should therefore become a priority in the care of HIV infected individuals, along with public health efforts to prevent new HCV infections, focusing particularly on specific patient groups at risk, such as men who have sex with men and injecting drug users.
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Affiliation(s)
- Drosos E Karageorgopoulos
- Drosos E Karageorgopoulos, Joanna Allen, Sanjay Bhagani, Department of Infectious Diseases/HIV Medicine, Royal Free London NHS Foundation Trust, London NW3 2QG, United Kingdom
| | - Joanna Allen
- Drosos E Karageorgopoulos, Joanna Allen, Sanjay Bhagani, Department of Infectious Diseases/HIV Medicine, Royal Free London NHS Foundation Trust, London NW3 2QG, United Kingdom
| | - Sanjay Bhagani
- Drosos E Karageorgopoulos, Joanna Allen, Sanjay Bhagani, Department of Infectious Diseases/HIV Medicine, Royal Free London NHS Foundation Trust, London NW3 2QG, United Kingdom
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Crowell TA, Berry SA, Fleishman JA, LaRue RW, Korthuis PT, Nijhawan AE, Moore RD, Gebo KA. Impact of hepatitis coinfection on healthcare utilization among persons living with HIV. J Acquir Immune Defic Syndr 2015; 68:425-31. [PMID: 25559601 PMCID: PMC4336227 DOI: 10.1097/qai.0000000000000490] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
: Hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection are increasingly important sources of morbidity among HIV-infected persons. We determined associations between hepatitis coinfection and healthcare utilization among HIV-infected adults at 4 US sites during 2006-2011. Outpatient HIV visits did not differ by hepatitis serostatus and decreased over time. Mental health visits were more common among HIV/HCV coinfected persons than among HIV monoinfected persons [incidence rate ratio (IRR): 1.27, 95% confidence interval (CI): 1.08 to 1.50]. Hospitalization rates were higher among all hepatitis-infected groups than among HIV monoinfected (HIV/HBV: IRR: 1.23, 95% CI: 1.05 to 1.44; HIV/HCV: IRR: 1.22, 95% CI: 1.10 to 1.36; HIV/HBV/HCV: IRR: 1.31, 95% CI: 1.02 to 1.68). These findings may inform the design of clinical services and allocation of resources.
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Affiliation(s)
- Trevor A. Crowell
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen A. Berry
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John A. Fleishman
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD
| | - Richard W. LaRue
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - P. Todd Korthuis
- Department of Medicine, Oregon Health & Science University, Portland, OR
| | - Ank E. Nijhawan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelly A. Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Cenderello G, Tittle V, Pasa A, Dentone C, Artioli S, Setti M, Giacomini M, Fraccaro P, Viscoli C, Cassola G, Di Biagio A, Barbour A, Nelson M. Inpatient admissions of patients living with HIV in two European centres (UK and Italy); comparisons and contrasts. J Infect 2015; 70:690-4. [PMID: 25572999 DOI: 10.1016/j.jinf.2014.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 12/19/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Affiliation(s)
| | - Victoria Tittle
- HIV Unit, Chelsea & Westminster Hospital, London, United Kingdom
| | - Ambra Pasa
- Information Technology, EO Ospedali Galliera, Genoa, Italy
| | | | | | - Maurizio Setti
- Clinica ad Orientamento Immunologico, IRCCS AOU San Martino-IST, National Cancer Institute, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre & Health eResearch Centre, University of Manchester, Manchester, UK
| | - Paolo Fraccaro
- Department of Informatics, Bioengineering, Robotics and System Engineering, Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre & Health eResearch Centre, University of Manchester, Manchester, UK
| | - Claudio Viscoli
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST, National Cancer Institute, Genoa, Italy
| | | | - Antonio Di Biagio
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST, National Cancer Institute, Genoa, Italy
| | - Alison Barbour
- HIV Unit, Chelsea & Westminster Hospital, London, United Kingdom
| | - Mark Nelson
- HIV Unit, Chelsea & Westminster Hospital, London, United Kingdom
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Labarga P, Fernández-Montero JV, de Mendoza C, Barreiro P, Soriano V. Long-term survival and liver-related events after pegylated interferon/ribavirin therapy in HIV-infected patients with chronic hepatitis C. Antivir Ther 2014; 20:65-72. [PMID: 25105286 DOI: 10.3851/imp2827] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sustained HCV clearance after hepatitis C therapy is associated with reduced liver-related complications and death. It is unknown if treatment may provide any clinical benefit in patients that fail therapy. This could be particularly relevant in HIV-HCV-coinfected patients, in whom liver disease progresses more rapidly. METHODS This was a retrospective study of clinical end points in a large cohort of HIV-HCV-coinfected patients with compensated liver disease followed since 2004. Patients were stratified into three groups: treated and cured, treatment failures and non-treated. Follow-up ended at the time of last visit, first liver decompensation event or death. RESULTS A total of 527 HIV-HCV-coinfected patients were examined, of whom 339 (64.3%) had been treated with pegylated interferon/ribavirin. During a mean follow-up of 70.5 months, hepatic decompensation events or liver-related deaths occurred less frequently in cured patients (4/138; 2.9%) than in treatment failures (28/201; 13.9%) or untreated (25/188; 13.3%) patients (P<0.001). Interestingly, in the subset of patients with baseline advanced liver fibrosis (Metavir F3-F4), those with treatment failure experienced less hepatic decompensation events or deaths than untreated patients (19% versus 42%; P=0.005) and this finding was more pronounced in patients harbouring IL28B-CC alleles (15.8% versus 47.4%; P=0.02). CONCLUSIONS Sustained HCV clearance following pegylated interferon/ribavirin therapy is associated with a reduced incidence of liver complications and death in HIV-HCV-coinfected patients. In the subset of patients with baseline advanced liver fibrosis, treatment provides clinical benefit despite lack of sustained virological response. The transient antiviral and/or anti-inflammatory effect of interferon, more recognizable in IL28B-CC carriers, could explain this finding.
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Affiliation(s)
- Pablo Labarga
- Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain
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Keller SC, Yehia BR, Momplaisir FO, Eberhart MG, Share A, Brady KA. Assessing the overall quality of health care in persons living with HIV in an urban environment. AIDS Patient Care STDS 2014; 28:198-205. [PMID: 24654969 DOI: 10.1089/apc.2014.0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Ensuring high quality primary care for people living with HIV (PLWH) is important. We studied factors associated with meeting Health Resources and Services Administration-identified HIV performance measures, among a population-based sample of 376 PLWH in care at 24 Philadelphia clinics. Quality of care was assessed by a patient-level composite of 15 performance measures, focusing on HIV-specific care, vaccinations, and co-morbid condition screening. Adjusted incidence rate ratios (IRR) demonstrated relationships between patient and clinic factors and the performance measures score. The mean number of measures met was 8.52. Older age groups met more measures than 18- to 29-year-olds (age 40-49: adjusted IRR: 1.19, 95% CI: 1.05-1.35; age ≥50: adjusted IRR: 1.19, 95% CI: 1.03-1.35). Higher CD4 counts were associated with meeting more measures compared to CD4 <200 cells/μL (CD4 350-499 cells/μL: adjusted IRR: 1.14, 95% CI: 1.02-1.28; ≥500 cells/μL: adjusted IRR: 1.12, 95% CI: 1.01-1.26). PLWH attending clinics that provide adherence counseling or case management met more measures (adjusted IRR: 1.12, 95% CI: 1.04-1.21; adjusted IRR: 1.08, 95% CI: 1.02-1.14; respectively) than those attending clinics without these services. Limitations include potentially poor performance measure documentation and equal treatment of measures. Future work should focus on improving compliance with performance measures.
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Affiliation(s)
- Sara C. Keller
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Baligh R. Yehia
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Florence O. Momplaisir
- Division of Infectious Diseases, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Michael G. Eberhart
- AIDS Activities Coordinating Office, City of Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Amanda Share
- AIDS Activities Coordinating Office, City of Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Kathleen A. Brady
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
- AIDS Activities Coordinating Office, City of Philadelphia Department of Public Health, Philadelphia, Pennsylvania
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