title: Hospitalization Rates and Reasons Among HIV Elite Controllers and Persons With Medically Controlled HIV Infection.
abstract: BACKGROUND
  Elite controllers spontaneously suppress human immunodeficiency virus (HIV) viremia but also demonstrate chronic inflammation that may increase risk of comorbid conditions. We compared hospitalization rates and causes among elite controllers to those of immunologically intact persons with medically controlled HIV.
  
  
  METHODS
  For adults in care at 11 sites from 2005 to 2011, person-years with CD4 T-cell counts ≥350 cells/mm(2) were categorized as medical control, elite control, low viremia, or high viremia. All-cause and diagnostic category-specific hospitalization rates were compared between groups using negative binomial regression.
  
  
  RESULTS
  We identified 149 elite controllers (0.4%) among 34 354 persons in care. Unadjusted hospitalization rates among the medical control, elite control, low-viremia, and high-viremia groups were 10.5, 23.3, 12.6, and 16.9 per 100 person-years, respectively. After adjustment for demographic and clinical factors, elite control was associated with higher rates of all-cause (adjusted incidence rate ratio, 1.77 [95% confidence interval, 1.21-2.60]), cardiovascular (3.19 [1.50-6.79]) and psychiatric (3.98 [1.54-10.28]) hospitalization than was medical control. Non-AIDS-defining infections were the most common reason for admission overall (24.1% of hospitalizations) but were rare among elite controllers (2.7%), in whom cardiovascular hospitalizations were most common (31.1%).
  
  
  CONCLUSIONS
  Elite controllers are hospitalized more frequently than persons with medically controlled HIV and cardiovascular hospitalizations are an important contributor.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Crowell
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Joel N
authors.initials: JN
authors.lastname: Blankson
authors.affiliation: Department of Public Health/Preventive Medicine, Oregon Health and Science University, Portland.
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine.
authors.forename: Baligh R
authors.initials: BR
authors.lastname: Yehia
authors.affiliation: Division of General Pediatrics, Children's Hospital of Philadelphia.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Rutstein
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: Center for Comprehensive Care, St Luke's Roosevelt Hospital Center.
authors.forename: Victoria
authors.initials: V
authors.lastname: Sharp
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
authors.forename: Ank E
authors.initials: AE
authors.lastname: Nijhawan
authors.affiliation: Department of Medicine, University of California, San Diego.
authors.forename: W Christopher
authors.initials: WC
authors.lastname: Mathews
authors.affiliation: Department of Medicine, Montefiore Medical Center.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Hanau
authors.affiliation: Trillium Health, Rochester, New York.
authors.forename: Roberto B
authors.initials: RB
authors.lastname: Corales
authors.affiliation: Montefiore Medical Group, Bronx.
authors.forename: Robert
authors.initials: R
authors.lastname: Beil
authors.affiliation: Tampa General Health Care, Florida.
authors.forename: Charurut
authors.initials: C
authors.lastname: Somboonwit
authors.affiliation: Department of Internal Medicine, Alameda County Medical Center, Oakland, California.
authors.forename: Howard
authors.initials: H
authors.lastname: Edelstein
authors.affiliation: Department of Medicine, Drexel University College of Medicine, Pennsylvania.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Allen
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014766:Viremia / Q000453:epidemiology; D055815:Young Adult
keywords: HIV; antiretroviral therapy; elite control; hospitalization; inflammation; psychiatric disease