Causes of Hospitalisation Over 2011-2018 Among a Cohort of People With HIV From a London Centre

Abstract

Objective: To describe the spectrum of ICD-10 classified causes for hospitalisations occurring between 2011/2012 and 2018 in a cohort of PLHIV.Methods: This sub-study includes 798 HIV-positive individuals participating in the Antiretroviral, Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study who were recruited from a large London centre. A medical record review identified the occurrence and causes of hospitalisation from the date of questionnaire completion (2011-2012) until 1 June 2018. Up to five causes were classified by an HIV clinician using the ICD-10 system.Results: There were 274 hospitalisations in 153 people (rate=5.8/100 person-years; 95% CI: 5.1, 6.5). Causes were wide-ranging; the most common were circulatory (16.8%), digestive (13.1%), respiratory (11.7%), infectious diseases (11.0%), injury/poisoning (10.6%), genitourinary diseases (9.9%) and neoplasms (9.1%). A tenth (27/274) of hospitalisations were related to at least one AIDS-defining illness. Median duration of hospitalisation was 5 days. At the time of hospitalisation, median CD4 count was high (510 cells/µl; IQR: 315-739), while median CD4 nadir was relatively low (113 cells/µl; IQR: 40-239). At admission, half of individuals (51%) had a previous AIDS-defining illness and 21% had viral load >50 copies/ml. Individuals admitted for infectious diseases were particularly likely to have unfavourable clinical characteristics (low CD4, viral non-suppression, not on ART, previous AIDS).Conclusions: In the modern cART era, the spectrum of causes of hospitalisation in PLHIV in the UK is wide-ranging, highlighting the importance of holistic care for PLHIV, including prevention, early detection and treatment of comorbidities.