Decline in hospital readmissions observed among patients with HIV in US and Canada

Hospital readmissions among patients with HIV infection have been decreasing, most likely due to expanded use of antiretroviral therapy and more effective regimens, according to results of a study published in The Journal of Infectious Diseases.

Hospital readmissions are more frequent among patients with HIV infection than the general population. Therefore, efforts to reduce readmissions in this patient population has been a focus of health policies.

To evaluate recent trends in hospital readmissions in the HIV setting, researchers sourced data for this study from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) consortium. Patients (N=8823) who were discharged from the hospital between 2005 and 2018 with no discharge in the previous 30 days were included in the analysis. The primary outcome was readmission within 30 days, defined as hospital readmission within 30 days of the index hospitalization discharge. Covariates assessed included sex, race/ethnicity, age, risk for HIV acquisition, CD4⁺ count, viral load, history of AIDS-defining illness, and inclusion in the NA-ACCORD cohort. The absolute annual change in the probability of readmission was estimated via linear risk models, with discharge year as a linear variable.

The study population comprised 73% cisgendered men, of whom 38% were White, 38% were Black, 41% were men who have sex with men, 19% were injection drug users, and 36% had a history of AIDS. Overall, 20,189 index hospitalizations were assessed, with a median of 1 (IQR, 1-3) hospitalization per patient.

The overall probability of readmission was 17.6% (95% CI, 17.0-18.2), which was observed to decrease over time from 20.1% (95% CI, 17.9-22.3) in 2005 to 16.3% (95% CI, 14.1-18.5) in 2018. After adjusting for confounders, the researchers observed that the absolute rate of readmissions had been declining by 0.19% (95% CI, -0.35 to -0.02) per year.

Stratified by type of readmission, reductions in per-year readmissions were observed for cardiovascular (-0.47%; 95% CI, -0.94 to -0.01) and psychiatric (-0.46%; 95% CI, -0.92 to -0.00) indications. The researchers also noted nonsignificant per-year reductions in readmissions for non-AIDS-defining infections (-0.20%; 95% CI, -0.47 to 0.07), AIDS-defining illness (0.22; 95% CI, -0.51 to 0.96), liver or gastrointestinal indications (-0.06%; 95% CI, -0.58 to 0.45), and endocrine or metabolic indications (-0.06%; 95% CI, -0.77 to 0.64).

Readmissions within 30 days were more common among patients with CD4⁺ counts below 50 (adjusted risk difference [aRD], 10.14%), between 50 and 200 (aRD, 5.52%), and between 201 and 350 cells/µL (aRD, 2.53%) compared with those with CD4⁺ counts above 500 cells/µL. Readmissions also were more common among patients with vs without a history of AIDS (aRD, 3.34%), as well as among those aged 60 years and older (aRD, 3.28%) or 50 to 59 years (aRD, 2.42%) compared with those aged 40 years and younger.

“Earlier HIV diagnosis, the expanded recommendation of ART initiation to all PWH [people with HIV], and use of newer, more effective regimens, which led to increased virologic suppression rates and CD4 counts, likely contributed to the decrease in hospital readmissions,” the researchers noted.

Limitations of this study include potentially underestimated readmission rates as some patients may have been readmitted to hospitals outside of the medical system in which data were captured.

“Continued efforts are needed to further prevent readmissions in PWH, particularly those with greater immunodeficiency (as marked by low CD4 counts and history of AIDS-defining illness) and unsuppressed viral load,” the researchers concluded.

Disclosures: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

By Jessica Nye, PhD

References:

Davy-Mendez T, Napravnik S, Hogan BC, et al. Hospital readmissions among persons with HIV in the United States and Canada, 2005–2018: a collaboration of cohort studies. J Infect Dis. Published online September 12, 2023. doi:10.1093/infdis/jiad396

SEE ALSO:

• Healio: HIV hospital readmissions decreased between 2005 and 2018