Current and Past Immunodeficiency Are Associated with Higher Hospitalization Rates among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years

Thibaut Davy-Mendez, Sonia Napravnik, Joseph J. Eron, Stephen R. Cole, David Van Duin, David A. Wohl, Brenna C. Hogan, Keri N. Althoff, Kelly A. Gebo, Richard D. Moore, Michael J. Silverberg, Michael A. Horberg, M. John Gill, W. Christopher Mathews, Marina B. Klein, Jonathan A. Colasanti, Timothy R. Sterling, Angel M. Mayor, Peter F. Rebeiro, Kate BuchaczJun Li, Ni Gusti Ayu Nanditha, Jennifer E. Thorne, Ank Nijhawan, Stephen A. Berry, Constance A. Benson, Ronald J. Bosch, Gregory D. Kirk, Kenneth H. Mayer, Chris Grasso, Robert S. Hogg, Julio S.G. Montaner, Kate Salters, Viviane D. Lima, Paul Sereda, Jason Trigg, Kate Buchacz, Jun Li, Kelly A. Gebo, Richard D. Moore, Richard D. Moore, Benigno Rodriguez, Michael A. Horberg, Michael J. Silverberg, Jennifer E. Thorne, Todd Brown, Phyllis Tien, Gypsyamber D'souza, Charles Rabkin, Marina B. Klein, Abigail Kroch, Ann Burchell, Adrian Betts, oanne Lindsay, Robert F. Hunter-Mellado, Angel M. Mayor, M. John Gill, Jeffrey N. Martin, Jun Li, John T. Brooks, Michael S. Saag, Michael J. Mugavero, James Willig, William C. Mathews, Joseph J. Eron, Sonia Napravnik, Mari M. Kitahata, Heidi M. Crane, Timothy R. Sterling, David Haas, Peter Rebeiro, Megan Turner, Janet Tate, Robert Dubrow, David Fiellin, Richard D. Moore, Keri N. Althoff, Stephen J. Gange, Mari M. Kitahata, Michael S. Saag, Michael A. Horberg, Marina B. Klein, Rosemary G. Mckaig, Aimee M. Freeman, Richard D. Moore, Keri N. Althoff, Aimee M. Freeman, Mari M. Kitahata, Stephen E. Van Rompaey, Heidi M. Crane, Liz Morton, Justin Mcreynolds, William B. Lober, Stephen J. Gange, Keri N. Althoff, Jennifer S. Lee, Bin You, Brenna Hogan, Jinbing Zhang, Jerry Jing, Elizabeth Humes, Lucas Gerace, Sally Coburn

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Persons with human immunodeficiency virus (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk. Methods: In 6 US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (years 2-5) and long-term (years 6-11) suppression and lowest presuppression CD4 count <200 and ≥200 cells/μL, Poisson regression models estimated hospitalization incidence rate ratios (aIRRs) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest presuppression CD4 count. Results: The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% white. Among patients with lowest presuppression CD4 count <200 cells/μL (44%), patients with current CD4 count 200-350 vs >500 cells/μL had aIRRs of 1.44 during early suppression (95% confidence interval [CI], 1.01-2.06), and 1.67 (95% CI, 1.03-2.72) during long-term suppression. Among patients with lowest presuppression CD4 count ≥200 (56%), patients with current CD4 351-500 vs >500 cells/μL had an aIRR of 1.22 (95% CI,. 93-1.60) during early suppression and 2.09 (95% CI, 1.18-3.70) during long-term suppression. Conclusions: Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates and could potentially benefit from targeted clinical management strategies.

Original languageEnglish (US)
Pages (from-to)657-666
Number of pages10
JournalJournal of Infectious Diseases
Volume224
Issue number4
DOIs
StatePublished - Aug 15 2021

Keywords

  • CD4 lymphocyte count
  • HIV
  • cohort studies
  • hospitalization
  • sustained virologic response

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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