Hospitalizations in a cohort of HIV patients in Australia, 1999-2007.
OBJECTIVE
To describe hospitalization rates, risk factors and associated diagnoses in people with HIV in Australia between 1999 and 2007.


METHODS
Retrospective cohort study of people with HIV (n = 842) using data linkage between the Australian HIV Observational Database and administrative hospital morbidity data collections.


METHODS
Incidence rate ratios with 95% confidence intervals were estimated using Poisson regression models to assess risk factors for hospitalization. Predictors of length of stay were assessed using generalized mixed models. The association between hospitalization and mortality was assessed using Cox regression.


RESULTS
In 4519 person-years of observation, there were 2667 hospital admissions; incidence rate of 59 per 100 person-years. Hospitalization rates were 50-300% higher in this cohort than comparable age and sex strata in the general population. Older age (incidence rate ratio 1.46, 95% confidence interval 1.28-1.65 per 10-year increase) and prior AIDS (incidence rate ratio 1.71, 95% confidence interval 1.24-2.35) were significantly associated with hospitalization. Other predictors of hospitalization included lower CD4 cell counts, higher HIV RNA, longer duration of HIV infection and experience with more drug classes. Lower CD4 cell counts, older age and hepatitis C virus antibody positivity were independently associated with longer hospital stay. Non-AIDS diseases were the principle reason for admission in the majority of cases. Mortality was associated with more frequent hospitalization during the study period.


CONCLUSIONS
Hospitalization rates are higher in people with HIV than the general population in Australia and are associated with markers of advanced HIV disease despite the widespread use of combination antiretroviral therapy.
Falster
Kathleen
K
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia. kathleen.falster@saxinstitute.org.au <kathleen.falster@saxinstitute.org.au>
Wand
Handan
H
Donovan
Basil
B
Anderson
Jonathan
J
Nolan
David
D
Watson
Kerrie
K
Watson
Jo
J
Law
Matthew G
MG
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001315:Australia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D003625:Data Collection; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged