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J Infect Dis. 2015 Jun 1;211(11):1692-702. doi: 10.1093/infdis/jiu809. Epub 2014 Dec 15.

Hospitalization Rates and Reasons Among HIV Elite Controllers and Persons With Medically Controlled HIV Infection.

Author information

1
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
2
Department of Public Health/Preventive Medicine, Oregon Health and Science University, Portland.
3
Department of Medicine, University of Pennsylvania Perelman School of Medicine.
4
Division of General Pediatrics, Children's Hospital of Philadelphia.
5
Center for Comprehensive Care, St Luke's Roosevelt Hospital Center.
6
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
7
Department of Medicine, University of California, San Diego.
8
Department of Medicine, Montefiore Medical Center.
9
Trillium Health, Rochester, New York.
10
Montefiore Medical Group, Bronx.
11
Tampa General Health Care, Florida.
12
Department of Internal Medicine, Alameda County Medical Center, Oakland, California.
13
Department of Medicine, Drexel University College of Medicine, Pennsylvania.

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.

KEYWORDS:

HIV; antiretroviral therapy; elite control; hospitalization; inflammation; psychiatric disease

PMID:
25512624
PMCID:
PMC4447832
DOI:
10.1093/infdis/jiu809
[Indexed for MEDLINE]
Free PMC Article

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