title: Impact of hepatitis coinfection on hospitalization rates and causes in a multicenter cohort of persons living with HIV.
abstract: BACKGROUND
  Chronic viral hepatitis is a potentially important determinant of health care utilization among persons living with HIV. We describe hospitalization rates and reasons for hospitalization among persons living with HIV stratified by coinfection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV).
  
  
  METHODS
  Laboratory, demographic, and hospitalization data were obtained for all patients receiving longitudinal HIV care during 2010 at 9 geographically diverse sites. Hepatitis serostatus was assessed by hepatitis B surface antigen and/or hepatitis C antibody. ICD-9 codes were used to assign hospitalizations into diagnostic categories. Negative binomial regression was used to assess factors associated with all-cause and diagnostic category-specific hospitalizations.
  
  
  RESULTS
  A total of 2793 hospitalizations were observed among 12,819 patients. Of these patients, 49.3% had HIV monoinfection, 4.1% HIV/HBV, 15.4% HIV/HCV, 2.5% HIV/HBV/HCV, and 28.7% unknown hepatitis serostatus. Compared with HIV monoinfection, the risk of all-cause hospitalization was increased with HIV/HBV [adjusted incidence rate ratio 1.55 (1.17 to 2.06)], HIV/HCV [1.45 (1.21 to 1.74)], and HIV/HBV/HCV [1.52 (1.04 to 2.22)]. Risk of hospitalization for non-AIDS-defining infection was also higher among patients with HIV/HBV [2.07 (1.38 to 3.11)], HIV/HCV [1.81 (1.36 to 2.40)], and HIV/HBV/HCV [1.96 (1.11 to 3.46)]. HIV/HBV was associated with hospitalization for gastrointestinal/liver disease [2.55 (1.30 to 5.01)]. HIV/HCV was associated with hospitalization for psychiatric illness [1.89 (1.11 to 3.26)].
  
  
  CONCLUSIONS
  HBV and HCV coinfection are associated with increased risk of all-cause hospitalization and hospitalization for non-AIDS-defining infections, as compared with HIV monoinfection. Policy-makers and third-party payers should be aware of the heightened risk of hospitalization associated with coinfection when allocating health care resources and considering models of health care delivery.
authors.affiliation: Departments of *Medicine and †Pediatrics Johns Hopkins University, Baltimore, MD; and ‡Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Crowell
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
authors.forename: Ashwin
authors.initials: A
authors.lastname: Balagopal
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.forename: Allison L
authors.initials: AL
authors.lastname: Agwu
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D060085:Coinfection / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000473:pathology*; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies