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Reasons for Hospitalizations that Occur after
HAART InitiationStephen A Berry, Yukari C
Manabe, Richard D Moore, Kelly A Gebo Johns
Hopkins University School of Medicine, Baltimore,
MD, USA
O-219 CROI Montreal, QC February 8 11, 2009
Stephen A. Berry, M.D. 1830 E. Monument Street /
Suite 452 Baltimore, MD 21287Phone
410-502-8829 Fax [phone]Email
sberry8_at_jhmi.edu
Table 1. Baseline Characteristics Table 1. Baseline Characteristics Table 1. Baseline Characteristics Table 1. Baseline Characteristics Table 1. Baseline Characteristics Table 1. Baseline Characteristics Table 1. Baseline Characteristics Table 1. Baseline Characteristics Table 1. Baseline Characteristics Table 1. Baseline Characteristics Table 1. Baseline Characteristics
Age at HAART Age at HAART Age at HAART Age at HAART CD4 Count at HAART CD4 Count at HAART CD4 Count at HAART CD4 Count at HAART
18-29 years 238 (12) lt50 cells / mm3 576 (28)
30-39 878 (43) 50-199 623 (31)
40-49 691 (34) 200-349 460 (23)
gt50 224 (11) gt350 372 (18)
Median (IQR) in years Median (IQR) in years Median (IQR) in years Median (IQR) in years 39 (33.7, 44.1) Median (IQR) in cells / mm3 Median (IQR) in cells / mm3 Median (IQR) in cells / mm3 Median (IQR) in cells / mm3 152 (37, 298)

Gender Gender Gender Gender HIV RNA at HAART HIV RNA at HAART HIV RNA at HAART HIV RNA at HAART
Women Women Women 688 (34) lt4 Log10 copies/mL 415 (20)
Men Men Men 1343 (66) 4-5 765 (38)
gt5 851 (42)
Racial / Ethnic Category Racial / Ethnic Category Racial / Ethnic Category Racial / Ethnic Category Racial / Ethnic Category Median (IQR) in Log10 copies/mL Median (IQR) in Log10 copies/mL Median (IQR) in Log10 copies/mL Median (IQR) in Log10 copies/mL 4.8 (4.1, 5.3)
African American (AA) African American (AA) African American (AA) 1550 (76)
White White White 438 (22) HAART Type HAART Type HAART Type HAART Type
Hispanic (non-AA) Hispanic (non-AA) Hispanic (non-AA) 20 (1) NNRTI (plus gt2 NRTIs) NNRTI (plus gt2 NRTIs) NNRTI (plus gt2 NRTIs) 566 (28)
Asian Asian Asian 6 (lt1) PI (plus gt2 NRTIs) PI (plus gt2 NRTIs) PI (plus gt2 NRTIs) 1238 (61)
Other Other Other 17 (1) PI and NNRTI (plus gt1 NRTI) PI and NNRTI (plus gt1 NRTI) PI and NNRTI (plus gt1 NRTI) 181 (9)
gt 3 NRTIs (w/o PI or NNRTI) gt 3 NRTIs (w/o PI or NNRTI) gt 3 NRTIs (w/o PI or NNRTI) 46 (2)
HIV Risk Factors HIV Risk Factors HIV Risk Factors HIV Risk Factors
IDU IDU IDU 435 (21) Calendar Era at HAART Calendar Era at HAART Calendar Era at HAART Calendar Era at HAART
IDU-Heterosexual IDU-Heterosexual IDU-Heterosexual 391 (19) 1996-1998 1996-1998 1996-1998 1093 (54)
IDU-MSM IDU-MSM IDU-MSM 89 (4) 1999-2002 1999-2002 1999-2002 603 (30)
Heterosexual Heterosexual Heterosexual 539 (27) 2003-2005 2003-2005 2003-2005 335 (17)
MSM MSM MSM 457 (23)
Unknown / Other Unknown / Other Unknown / Other 120 (6)
All values are number of patients ( of total) unless otherwise specified. IDU, injection drug user MSM, men who have sex with men NNRTI, non-nucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor PI, protease inhibitor. All values are number of patients ( of total) unless otherwise specified. IDU, injection drug user MSM, men who have sex with men NNRTI, non-nucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor PI, protease inhibitor. All values are number of patients ( of total) unless otherwise specified. IDU, injection drug user MSM, men who have sex with men NNRTI, non-nucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor PI, protease inhibitor. All values are number of patients ( of total) unless otherwise specified. IDU, injection drug user MSM, men who have sex with men NNRTI, non-nucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor PI, protease inhibitor. All values are number of patients ( of total) unless otherwise specified. IDU, injection drug user MSM, men who have sex with men NNRTI, non-nucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor PI, protease inhibitor. All values are number of patients ( of total) unless otherwise specified. IDU, injection drug user MSM, men who have sex with men NNRTI, non-nucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor PI, protease inhibitor. All values are number of patients ( of total) unless otherwise specified. IDU, injection drug user MSM, men who have sex with men NNRTI, non-nucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor PI, protease inhibitor. All values are number of patients ( of total) unless otherwise specified. IDU, injection drug user MSM, men who have sex with men NNRTI, non-nucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor PI, protease inhibitor. All values are number of patients ( of total) unless otherwise specified. IDU, injection drug user MSM, men who have sex with men NNRTI, non-nucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor PI, protease inhibitor. All values are number of patients ( of total) unless otherwise specified. IDU, injection drug user MSM, men who have sex with men NNRTI, non-nucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor PI, protease inhibitor. All values are number of patients ( of total) unless otherwise specified. IDU, injection drug user MSM, men who have sex with men NNRTI, non-nucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor PI, protease inhibitor.
Interpretation Hospitalizations for Non-AIDS
defining infections, AIDS defining illnesses and
psychiatric illnesses decreased statistically
significantly within the year after HAART
initiation, while hospitalizations for other
illnesses did not.
Table 3.. Multivariate Analysis of Factors Associated with Hospitalization Rates Table 3.. Multivariate Analysis of Factors Associated with Hospitalization Rates Table 3.. Multivariate Analysis of Factors Associated with Hospitalization Rates Table 3.. Multivariate Analysis of Factors Associated with Hospitalization Rates Table 3.. Multivariate Analysis of Factors Associated with Hospitalization Rates Table 3.. Multivariate Analysis of Factors Associated with Hospitalization Rates Table 3.. Multivariate Analysis of Factors Associated with Hospitalization Rates
All Cause Non-ADI Inf ADI Psych
Time with respect to HAART Time with respect to HAART Time with respect to HAART
Prior 180 days Prior 180 days 1.00 (ref) 1.00 (ref) 1.00 (ref) 1.00 (ref)
Days 1-45 Days 1-45 0.99 (0.82, 1.19) 1.07 (0.77, 1.49) 1.03 (0.75, 1.42) 0.64 (0.35, 1.17)
Days 46-90 Days 46-90 0.75 (0.61, 0.92) 0.82 (0.56, 1.20) 0.63 (0.43, 0.94) 0.68 (0.37, 1.25)
Days 91-180 Days 91-180 0.75 (0.62, 0.90) 0.75 (0.53, 1.04) 0.55 (0.39, 0.78) 0.50 (0.28, 0.88)
Days 181-365 Days 181-365 0.73 (0.62, 0.86) 0.73 (0.56, 0.96) 0.40 (0.29, 0.55) 0.64 (0.40, 1.04)

Age at HAART gt 39 years Age at HAART gt 39 years Age at HAART gt 39 years 1.18 (1.00, 1.40) 1.33 (1.06, 1.68) --- 0.60 (0.39, 0.93)

Women Women Women 1.41 (1.20, 1.68) 1.68 (1.34, 2.12) --- 1.58 (1.05, 2.37)

African American African American African American 1.25 (1.00, 1.58) 1.85 (1.31, 2.61) --- 1.23 (0.69, 2.22)

IDU IDU IDU 1.37 (1.16, 1.62) 1.52 (1.20, 1.94) --- 2.91 (1.90, 4.48)

CD4 count at HAART CD4 count at HAART CD4 count at HAART ---
lt50 cells/mm3 lt50 cells/mm3 2.80 (2.22, 3.53) 2.62 (1.90, 3.60) 10.42 (6.45, 16.83)
50-199 50-199 1.43 (1.13, 1.81) 1.62 (1.17, 2.25) 2.73 (1.61, 4.62)
gt200 gt200 1.00 (ref) 1.00 (ref) 1.00 (ref)

HIV-1 RNA at HAART HIV-1 RNA at HAART HIV-1 RNA at HAART ---
lt4 Log10 copies/mL lt4 Log10 copies/mL 1.00 (ref) 1.00 (ref) 1.00 (ref)
4-5 4-5 0.94 (0.74, 1.19) 1.25 (0.87, 1.81) 0.87 (0.56, 1.37)
gt5 gt5 1.27 (0.99, 1.63) 1.81 (1.25, 2.60) 1.28 (0.84, 1.94)

Calendar era at HAART Calendar era at HAART Calendar era at HAART
1996-1998 1996-1998 1.00 (ref) 1.00 ref 1.00 (ref) ---
1999-2002 1999-2002 1.13 (0.94, 1.36) 1.22 (0.93, 1.58) 0.99 (0.71, 1.37)
2003-2005 2003-2005 1.20 (0.96, 1.51) 1.35 (0.99, 1.83) 0.76 (0.49, 1.18)
--- Indicates not included in multivariate model because bivariate Pgt0.20. HAART type (NNRTI plus gt2 NRTIs, PI plus gt2 NRTIs, PI NNRTI plus gt1 NRTI), and gt3 NRTIs) was not associated with admissions in any category in bivariate analyses. --- Indicates not included in multivariate model because bivariate Pgt0.20. HAART type (NNRTI plus gt2 NRTIs, PI plus gt2 NRTIs, PI NNRTI plus gt1 NRTI), and gt3 NRTIs) was not associated with admissions in any category in bivariate analyses. --- Indicates not included in multivariate model because bivariate Pgt0.20. HAART type (NNRTI plus gt2 NRTIs, PI plus gt2 NRTIs, PI NNRTI plus gt1 NRTI), and gt3 NRTIs) was not associated with admissions in any category in bivariate analyses. --- Indicates not included in multivariate model because bivariate Pgt0.20. HAART type (NNRTI plus gt2 NRTIs, PI plus gt2 NRTIs, PI NNRTI plus gt1 NRTI), and gt3 NRTIs) was not associated with admissions in any category in bivariate analyses. --- Indicates not included in multivariate model because bivariate Pgt0.20. HAART type (NNRTI plus gt2 NRTIs, PI plus gt2 NRTIs, PI NNRTI plus gt1 NRTI), and gt3 NRTIs) was not associated with admissions in any category in bivariate analyses. --- Indicates not included in multivariate model because bivariate Pgt0.20. HAART type (NNRTI plus gt2 NRTIs, PI plus gt2 NRTIs, PI NNRTI plus gt1 NRTI), and gt3 NRTIs) was not associated with admissions in any category in bivariate analyses. --- Indicates not included in multivariate model because bivariate Pgt0.20. HAART type (NNRTI plus gt2 NRTIs, PI plus gt2 NRTIs, PI NNRTI plus gt1 NRTI), and gt3 NRTIs) was not associated with admissions in any category in bivariate analyses.
Interpretation The decrease in infectious and
psychiatric hospitalizations after HAART
initiation occurs primarily among virologic
responders. For virologic responders during days
1-45 after HAART initiation, immune
reconstitution inflammatory syndromes account for
gt50 of hospitalizations due to AIDS defining
illnesses and 13 of all hospitalizations.
Table 2. Top 3 Reasons for Hospitalization by Category Table 2. Top 3 Reasons for Hospitalization by Category Table 2. Top 3 Reasons for Hospitalization by Category
Category No. ( of all admissions) Most Common ICD9-based Diagnoses1 (percent of the category)
Non-AIDS Defining Infections 459 (26) Pneumonia organism NOS (16), bacterial endocarditis (6), cellulitis of leg (6)
AIDS Defining Illnesses 406 (23) Pneumocystosis (25), cryptococcosis (17), candidal esophagitis (11)
Psychiatric 200 (11) Recurrent major depression (26), depressive disorder NEC (14), drug-induced depression (12)
Gastrointestinal and Liver 92 (5) Acute pancreatitis (13), chronic pancreatitis (8), cirrhosis of liver NOS (4), gastrointestinal hemorrhage NOS (4)
Endocrine, Nutritional, Metabolic, and Immunity 82 (5) Hypovolemia (37), cachexia (7), hypercalcemia (6)
Renal and Genitourinary 76 (4) Acute renal failure NOS (22), hypertensive renal failure (18), lower nephron nephrosis (9)
Circulatory 74 (4) Venous thrombosis (15), stroke (9), congestive heart failure (9)
Non-AIDS Defining Neoplasms 64 (4) Chemotherapy visit (42), reticulosarcoma NOS (6), metastasis to bone (6)
Injury and Poisoning 60 (3) Complication of dialysis (13) or vascular (7) device, poisoning antidepressant (5)
Pulmonary 50 (3) Asthma (52), spontaneous pneumothorax NEC (6), chronic bronchitis (4)
Hematologic 45 (3) Anemia NOS (22), aplastic anemias NEC (20), agranulocytosis (11)
Diagnostic categories which each had lt2 of all admissions included symptomatic classification, neurologic, obstetric and gynecologic, orthopedic, dermatologic, congenital conditions (0), and perinatal conditions (0). Diagnostic categories which each had lt2 of all admissions included symptomatic classification, neurologic, obstetric and gynecologic, orthopedic, dermatologic, congenital conditions (0), and perinatal conditions (0). Diagnostic categories which each had lt2 of all admissions included symptomatic classification, neurologic, obstetric and gynecologic, orthopedic, dermatologic, congenital conditions (0), and perinatal conditions (0).