Changes in the Prevalence of Non-AIDS Conditions Among Hospitalized Persons With HIV in the United States and Canada, 2008-2018

Abstract

Background: Hospitalization causes among persons with HIV (PWH) have shifted to non-AIDS conditions, but the complete disease profile of hospitalized PWH has not been well described. To inform hospitalization and readmission prevention efforts, we examined non-AIDS disease prevalence among PWH hospitalized in 4 US cohorts and 1 Canadian cohort.

Methods: Among PWH with ≥1 hospitalization from 2008 to 2018, we used log-binomial regression with generalized estimating equations to estimate trends in the annual prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease (CKD) stage ≥3, and multimorbidity (≥2 and ≥3 conditions), defined using longitudinal diagnosis, medication, and laboratory data.

Results: We examined 6781 hospitalized PWH who were 75% cisgender men, 40% White, and 38% Black. From 2008 to 2018, the proportion of PWH in care who had ≥1 hospitalization decreased from 9.6% to 6.3%. Age- and cohort-adjusted prevalence increased for hyperlipidemia (relative change per year: 3.6% [95% CI: 2.5%-4.7%]), diabetes mellitus (2.8% [1.3%-4.4%]), CKD (3.3% [1.7%-4.9%]), ≥2 conditions (1.3% [0.6%-2.0%]), and ≥3 conditions (3.0% [1.7%-4.3%]), decreased for HCV infection (-2.0% [-3.0%, -0.9%]), and remained stable for HBV infection (1.6% [-1.1%, 4.3%]) and hypertension (0.4% [-0.2%, 1.1%]).

Conclusions: Hospitalized PWH had an increasing burden of several non-AIDS conditions and multimorbidity not accounted for by aging alone. Further work is needed to understand these conditions' role in hospitalization risk among PWH. Our findings reinforce that hospital discharge planning in PWH should include efforts to ensure chronic conditions are adequately managed.

Keywords: HIV; aging; comorbidity; hyperlipidemia; hypertension.