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- Title
Current and Past Immunodeficiency are Associated with Higher Hospitalization Rates among Persons on Virologically Suppressive Antiretroviral Therapy for up to Eleven Years.
- Authors
Davy-Mendez, Thibaut; Napravnik, Sonia; Eron, Joseph J; Cole, Stephen R; Duin, David van; Wohl, David A; Hogan, Brenna C; Althoff, Keri N; Gebo, Kelly A; Moore, Richard D; Silverberg, Michael J; Horberg, Michael A; Gill, M John; Mathews, W Christopher; Klein, Marina B; Colasanti, Jonathan A; Sterling, Timothy R; Mayor, Angel M; Rebeiro, Peter F; Buchacz, Kate
- Abstract
<bold>Background: </bold>Persons with HIV (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk.<bold>Methods: </bold>In six 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 pre-suppression CD4 count <200 and ≥200 cells/µL, Poisson regression models estimated hospitalization incidence rate ratios (aIRR) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest pre-suppression CD4 count.<bold>Results: </bold>The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% White. Among patients with lowest pre-suppression CD4 <200 cells/μL (44%), patients with current CD4 200-350 versus >500 cells/μL had an aIRR of 1.44 during early suppression (95% CI 1.01-2.06), and 1.67 (1.03-2.72) during long-term suppression. Among patients with lowest pre-suppression CD4 ≥200 (56%), patients with current CD4 351-500 versus >500 cells/μL had an aIRR of 1.22 (0.93-1.60) during early suppression and 2.09 (1.18-3.70) during long-term suppression.<bold>Conclusions: </bold>Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates, and could potentially benefit from targeted clinical management strategies.
- Subjects
ANTIRETROVIRAL agents; CD4 lymphocyte count; HIV; POISSON regression; HOSPITAL care
- Publication
Journal of Infectious Diseases, 2021, Vol 224, Issue 4, p657
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jiaa786