HBV/HIV coinfection is associated with poorer outcomes in hospitalized patients with HBV or HIV.
We examined the impact of HBV/HIV coinfection on outcomes in hospitalized patients compared to those with HBV or HIV monoinfection. Using the 2011 US Nationwide Inpatient Sample, we identified patients who had been hospitalized with HBV or HIV monoinfection or HBV/HIV coinfection using ICD-9-CM codes. We compared liver-related admissions between the three groups. Multivariable logistic regression was performed to identify independent predictors of in-hospital mortality, length of stay and total charges. A total of 72 584 discharges with HBV monoinfection, 133 880 discharges with HIV monoinfection and 8156 discharges with HBV/HIV coinfection were included. HBV/HIV coinfection was associated with higher mortality compared to HBV monoinfection (OR 1.67, 95% CI 1.30-2.15) but not when compared to HIV monoinfection (OR 1.22, 95% CI 0.96-1.54). However, the presence of HBV along with cirrhosis or complications of portal hypertension was associated with three times greater in-hospital mortality in patients with HIV compared to those without these complications (OR 3.00, 95% CI 1.80-5.02). Length of stay and total hospitalization charges were greater in the HBV-/HIV-coinfected group compared to the HBV monoinfection group (+1.53 days, P < 0.001; $17595, P < 0.001) and the HIV monoinfection group (+0.62 days, P = 0.034; $8840, P = 0.005). In conclusion, HBV/HIV coinfection is a risk factor for in-hospital mortality, particularly in liver-related admissions, compared to HBV monoinfection. Overall healthcare utilization from HBV/HIV coinfection is also higher than for either infection alone and higher than the national average for all hospitalizations, thus emphasizing the healthcare burden from these illnesses.
Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
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Rajbhandari
Harvard Medical School, Boston, MA, USA.
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Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
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Khalili
Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA. rtchung@partners.org.|Harvard Medical School, Boston, MA, USA. rtchung@partners.org.|Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. rtchung@partners.org.
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Chung
Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA. aananthakrishnan@partners.org.|Harvard Medical School, Boston, MA, USA. aananthakrishnan@partners.org.|Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. aananthakrishnan@partners.org.
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Ananthakrishnan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000473:pathology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000473:pathology*; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
HBV/HIV coinfection; hepatitis B; hospitalization; mortality; outcomes