Trends in Hospitalizations Among Children and Young Adults with Perinatally Acquired HIV (original) (raw)

2014, Pediatric Infectious Disease Journal

Background-Contemporary trends in hospitalization patterns among perinatally HIV-infected (PHIV) patients are unknown. We describe rates and reasons for hospitalizations stratified by age group during 2003-2010 within a large cohort of PHIV patients. Methods-579 PHIV patients engaged in care at 6 geographically-diverse pediatric HIV centers affiliated through the HIV Research Network were included. Modified Clinical Classification Software assigned primary ICD-9 codes into diagnostic categories. Analysis was performed using negative binomial regression with generalized estimating equations. Results-There were 699 all-cause hospitalizations. The overall rate for the full cohort was 19.9 / 100 person years, and overall rates for 0-4, 5-16, and 17-24 year-olds were 25.1, 14.7, and 34.2 / 100 person years, respectively. Declines were seen in unadjusted all-cause rates for the whole group (incidence rate ratio per year, 0.93 [0.87, 0.99]) and for 5-16 (0.87 [0.76, 0.99]) and 17-24 year-olds (0.87 [0.80, 0.95]). After adjustment for CD4, HIV-1 RNA, and demographics, rates were no longer declining. Non-AIDS-defining infections and AIDS-defining illnesses together caused 349 (50%) admissions. Declines in these categories drove the overall declines in unadjusted rates. No increases over time were seen for cardiovascular, renal, or any other diagnostic categories. Conclusions-While the declines in hospitalizations are reassuring, continued efforts are needed to address the persistently high infectious and non-infectious morbidity among PHIV patients. Innovative strategies may be most critical for 17-24 year-olds. Lack of increases in