|Table 2. Factors That Independently Affect Risk of Hospital Admission in 5 Disease Categories|
|Reason for Hospital Admission (Incidence Rate Ratios)|
|Digestive/Liver Disease||Kidney/Genitourinary||Non-AIDS Cancer||Lung Disease||Endocrine/Immune¶|
|Age 36-49*||--||↑ 1.44x||↑ 2.20x||↑ 1.87x||↑ 1.55x|
|Age 50+*||↑ 1.58x||↑ 2.16x||↑ 3.86x||↑ 3.00x||↑ 2.38x|
|Female vs male||--||↑ 1.31x||--||↑ 2.01x||↑ 1.41x|
|Black vs white||--||↑ 3.45x||--||--||↑ 2.01x|
|Hispanic vs white||↑ 1.50x||--||--||--||--|
|IDU vs non-IDU||↑ 1.62x||↑ 1.82x||--||↑ 2.37x||↑ 1.34x|
|CD4 at or under 50†||↑ 2.73x||↑ 4.77x||↑ 2.55x||↑ 4.21x||↑ 5.87x|
|CD4 51-200†||↑ 2.76x||↑ 2.66x||↑ 2.96x||↑ 3.05x||↑ 3.13x|
|CD4 201-350†||--||↑ 1.39x||↑ 1.66x||↑ 1.88x||↑ 1.44x|
|VL 50,000+ or missing‡||--||--||--||--||--|
* Compared with 18 to 35.
† Compared with over 350.
‡ Compared with under 400 copies.
¶ Includes endocrine, nutritional, metabolic, and immune diseases.
CD4, CD4 count; IDU, injection drug user; VL, viral load.
An up arrow (↑) means increased risk. A dash (--) means no significant association between the risk factor and hospital admission.
People admitted to the hospital with an AIDS illness had the longest hospital stays, averaging 10.5 days, followed by lung disease (8.3 days), psychiatric illness (7.9 days), non-AIDS cancers (7.7 days), and non-AIDS infections (7.3 days).
This large study of U.S. adults with HIV made several important findings about hospital admission rates and reasons for hospital admission.
First, AIDS illnesses caused fewer hospital admissions over the 2001-2008 study period. AIDS caused 18% of all admissions in 2001 and 8% in 2008. This drop reflects the improving CD4 counts and falling viral loads in the study group, which probably result from easier-to-take and stronger antiretroviral combinations. Also, people were probably starting antiretroviral therapy at higher CD4 counts and so spending less time with a dangerously low CD4 count. Still, AIDS remained a relatively frequent cause of hospital admission.
Second, non-AIDS infections like bacterial pneumonia caused most hospital admissions throughout the study period. From 2001 through 2008, researchers found no decline in the rate at which people went to the hospital with a non-AIDS infection. Preventing these infections remains a highly important part of HIV care. Factors that raise the risk of bacterial pneumonia include older age, lower CD4 count, smoking, other lung diseases, and heart disease.4
Third, the rates at which heart, kidney, and lung disease caused hospital admissions rose over the study period. The researchers say more work is needed to examine these results, because some other studies of people with HIV did not make similar findings. A large study in Denmark did find a rising rate of hospital admissions for heart disease for 1995 through 2007.5 At the same time, many studies show that heart, kidney, and lung disease are serious threats to people with HIV, even if they do not always send people to the hospital. HIV-positive people should take steps to avoid these diseases by quitting smoking, avoiding obesity, and exercising.
In people with and without HIV, older age raises the risk of hospital admission. By weighing the impact of other factors that increase chances of hospital admission, this study clearly showed that older age was not the only factor that affected the need for hospital care in this study group. HIV-positive people should keep in mind the other factors that raised the risk of hospital admission in this study group (Tables 1 and 2). For example, African Americans with and without HIV have a higher risk of kidney disease than whites. And this study confirmed that higher risk.
Among the risk factors that a person can change, CD4 count may be the most important. A U.S. government panel now recommends that anyone with HIV start antiretroviral therapy -- whatever their CD4 count.6 This study demonstrates that a CD4 count under 350 raises chances of hospital admission with both AIDS illnesses and non-AIDS illnesses.
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