Download Factors Associated with Admissions in HIV

Factors Associated
with Admissions in
HIV-1 Infected
Individuals in the
era of multiple HIV
Interventions
Patrick Carr, Colm Bergin, June Craig, Sarah O’Connell
Background
 30% increase in HIV diagnoses reported in Ireland between 2014
and 2015[1]
 Department of GU Medicine & Infectious Disease SJH
 250 new cases in 2014
 260 new cases in 2015
 Total cohort attending SJH = 2035
 2011 audit – 30.8% of HIV+ admissions were attributable to
symptomatic HIV infection [2]
 Many studies are showing that the trends in HIV admissions are
towards more non-AIDS defining admissions since the
introduction of combination anti-retroviral therapy (cART).[3][4][5][6]
Aims
 Primary aim
 Identify patient factors associated with admissions of
HIV positive individuals to SJH, in a 3 month period
over 3 years, April – June 2014 to April – June 2016.
 Secondary aims
 Examine trends of rates of opportunistic infection in
those presenting over time
 Compare demographics associated with
opportunistic infection [OI], HIV-related illness, and
HIV-unrelated illness.
 Compare demographics over the 3 year time point
Methods
 Single center retrospective cohort study
 All HIV-1 infected patients discharged from SJH between April to June, 2014
to 2016 respectively were identified
 Data was collected via electronic chart records and sorted on a
confidential excel database.
 Statistical analysis was performed using SPSS version 24. T test for continuous
variables and Chi Squared tests for catagorical variables
 Engagement in care was defined as at least one HIV care visit over one
year preceding date of hospital discharge.
 Oppertunistic Infection [OI] was defined as AIDS defining illness
 HIV-Related Illness was defined as clinical conditions assoc. with HIV
disease but not an OI
 HIV-Unrelated Illness was defined as clinical conditions not assoc. with HIV
Results
 168 patients with HIV infection were discharged from inpatient
care for the months April to June 2014, April –June 2015, and April –
June 2016.
 2016: 52 patients (28.3%) [Total 2016* – 184 [*Oct]]
 2015: 52 patients (21.7%) – [Total 2015 – 240]
 2014: 63 patients (25.7%) – [Total 2014 – 245]
 28 [17%] patients were admitted twice
 3 [2%] patients were admitted 3 times or more.
 14 [8%] patients presented as a new diagnosis.
 62 [63%] of patients resided outside the SJH catchment area.
 3 [2%] patients died during their admission.
 23 [14%] patients were readmitted within one month following
hospital discharge.
Reason For Admission
over Time
Presentation
60
50
OI
62
HIV - Related
38
HIV - unrelated
67
2014
2015
2016
30
[48%]
18
[35%]
14
[27%]
HIV - Related 16
[25%]
12
[23%]
10
[19%]
HIV Unrelated
17
[27%]
22
[42%]
28
[54%]
Total
63
52
52
40
OI
30
20
10
0
2014
OI
2015
HIV-Related
2016
Non-HIV Related
Total
Mean CD4 Count
600
500
Viral Load
100
90
P value – 0.001
P value – 0.009
80
70
400
60
300
50
40
200
30
20
100
10
0
0
Mean CD4
OI
HIV Related
Non-HIV Related
% Viral Load Detectable
OI
HIV Related
Non-HIV Related
Mean Bed Days [LOS]
25
P value – 0.008
20
Median Bed Days [LOS]
15
Median [IQR] length of stay was 7 [3,14]
bed days.
10
5
0
Mean Bed Days [LOS]
OI
HIV Related
Non-HIV Related
Engagement in Care
129 [84%] patients engaged in care
at the time of admission.
Engagement In Care
100
P value - <0.0001
90
Engaged In Care
80
100
90
70
80
70
60
60
50
50
40
30
40
20
10
30
0
2014
2015
2016
20
Engaged In Care
10
2014
40
[63%]
2015
45
[85%]
2016
44
[85%]
pvalue
0.023
0
% Engagement in Care
OI
HIV Related
Non-HIV Related
C2H5OH Excess
100
P value – 0.023
90
C2H5OH Excess
100
90
80
80
70
70
60
50
60
40
30
50
20
10
40
0
2014
30
2015
2016
C2H5OH Excess
20
2014
2015
2016
P-value
10
12 [19%]
12 [23%]
14 [27%]
0.091
0
% Excess Alcohol Intake
OI
HIV Related
Non-HIV Related
Hepatitis Co-infection
82 [49%] patients - hepatitis C co-infection
14 [8%] patients - hepatitis B co-infection
Hepatitis Co-infection
100
P value – <0.001
90
Hepatitis Co-infection
100
80
90
80
70
70
60
60
50
40
50
30
20
40
10
0
2014
2015
Hep C
2014
2015
2016
Hep B
2016
20
pvalue
Hep C 32
[51%]
26
[49%]
24
[46%]
0.034
Hep B
6
[11%]
2 [2%]
0.034
6
[10%]
30
10
0
Hep B Co-infection
OI
HIV Related
Hep C Co-infection
Non-HIV Related
Male
Age
85 [51%] were male
Age range was 24 to 75 years,
median [IQR]; 41 [36, 48] years.
Male [Gender]
Age [Years]
100
70
90
60
80
50
70
60
40
50
Male [Gender]
40
30
Age [Years]
30
20
20
10
10
0
0
2014
Male
2015
2016
2014
2014
2015
2016
36
[57%]
24
[45%]
26
[49%]
Age
2015
2016
2014
2015
2016
p-value
44
43
42
0.040
Smoking
Active IVDU
104 [62%] patients smokers at time of
admission.
29 [17%] patients actively injecting
drugs at the time of admission.
Smoker
Active IVDU
100
100
90
90
80
80
70
70
60
60
50
50
Smoker
40
40
30
30
20
20
10
0
10
2014
0
2014
Smoker
2015
2016
Active IVDU
2016
2014
2015
2016
38 [60%] 33 [62%] 33 [62%]
2015
Active
IVDU
2014
2015
2016
11 [17%] 11 [21%] 7 [13%]
On ARVs
100
90
80
70
60
50
On AVRs
40
30
20
10
0
2014
On ARVs
2015
2016
2014
2015
2016
p-value
35 [55%]
40 [75%]
43 [83%]
0.008
Mode Of Acquisition
100
P value – 0.016
90
Mode of Acquisition
29 [17%] patients were MSM, 101 [60%]
patients were IVDU, 34 [20%] were
heterosexual.
100
80
90
80
70
70
60
60
50
40
50
30
20
40
10
0
30
2014
2015
IVDU
20
10
0
MSM
OI
IVDU
HIV- Related
Heterosexual
Non-HIV Related
HS
MSM
2016
Other
2014
2015
2016
IVDU
32 [51%]
36 [68%]
33 [63%]
HS
17 [27%]
8 [15%]
9 [17%]
MSM
13 [20%]
8 [15%]
8 [15%]
Other
1 [2%]
1 [2%]
2 [2%]
Discussion
 Percentage of HIV-positive patients presenting
with an OI is decreasing over time, while
proportion with non-HIV associated illness is
increasing.
 This trend is reflective of numerous international
studies[2][3][4][5]
 Those who presented with an OI:
 Significantly lower CD4 count and higher HIV-1 viral
load
 Less likely to be engaged in care.
Discussion
 IVDU and HCV co-infected individuals were more
likely to be admitted for a non-HIV related illness
while the heterosexual risk group were more likely
to present with OI.
 The high percentage of viral load in the non-HIV
related admissions is note-worthy [31%] as this is
not in line with the total cohort – of whom <10%
have a detectable viral load[7]
Limitations
 Retrospective cohort study
 Retrospective bias
 Occasionally missing data
 Time Frame of the project
Conclusion
 An improved care package for the IVDU, HCV coinfected cohort needs to be developed to optimise
patient care and prevent hospital admissions and
healthcare costs.
 Need for improved screening and immediate ART given
the ongoing rate of opportunistic infections and new
diagnoses – especially amongst the heterosexual
population.
 This project should be extended to look at all admissions
over the 3 years and to review this on an annual basis
 This project should also be used to compare
demographics of the HIV-inpatient population to the
demographics of the total HIV+ cohort to gain a better
understanding of the characteristics of HIV admissions
Acknowledgements
 Dr Sarah O’Connell – ID Consultant Department
of Genito Urinary Medicine and Infectious
Diseases, SJH
 Professor Colm Bergin – Consultant Physician,
Department of Genito Urinary Medicine and
Infectious Diseases, SJH
 June Craig – GUIDE Clinic Data Manager, SJH
 HIV+ patients whom attend the SJH service
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