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J Acquir Immune Defic Syndr. 2019 Feb 1;80(2):145-151. doi: 10.1097/QAI.0000000000001904.

Medical Intensive Care Unit Admission Among Patients With and Without HIV, Hepatitis C Virus, and Alcohol-Related Diagnoses in the United States: A National, Retrospective Cohort Study, 1997-2014.

Author information

1
Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
2
Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT.
3
Internal Medicine, Yale School of Medicine, New Haven, CT.
4
Internal Medicine, University of Washington School of Medicine, Seattle, WA.
5
Infectious Diseases, VA Pittsburgh Healthcare System, Pittsburgh, PA.
6
Department of Medicine, Weill Cornell Medical College, New York City, NY.
7
Department of Medicine, Weill Cornell Medical College, Doha, Qatar.
8
Infectious Diseases, VA Medical Center, Washington, DC.
9
Department of Medicine, Medicine and Health Sciences, The George Washington University, Washington, DC.
10
Medicine, University of California, San Francisco, CA.
11
Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
12
David Geffen School of Medicine, University of California, Los Angeles, CA.
13
Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ.
14
Medicine, Michael E. DeBakey VA Medical Center, Houston, TX.
15
Medicine-Infectious Diseases, Baylor College of Medicine, Houston, TX.
16
Medicine, James J. Peters VA Medical Center, New York, NY.
17
Department of Medicine, Icahn School of Medicine, Mount Sinai, New York, NY.
18
Medicine, Vanderbilt University School of Medicine, Nashville, TN.
19
Geriatric Research Education and Clinical Centers, VA Tennessee Valley Healthcare System, Nashville, TN.
20
Critical Care Medicine, James J. Peters VA Medical Center, Bronx, NY.
21
Medicine, Emory University School of Medicine, Atlanta, GA.
22
Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT.
23
Internal Medicine, VA Connecticut Healthcare System, West Haven, CT.

Abstract

BACKGROUND:

HIV, hepatitis C virus (HCV), and alcohol-related diagnoses (ARD) independently contribute increased risk of all-cause hospitalization. We sought to determine annual medical intensive care unit (MICU) admission rates and relative risk of MICU admission between 1997 and 2014 among people with and without HIV, HCV, and ARD, using data from the largest HIV and HCV care provider in the United States.

SETTING:

Veterans Health Administration.

METHODS:

Annual MICU admission rates were calculated among 155,550 patients in the Veterans Aging Cohort Study by HIV, HCV, and ARD status. Adjusted rate ratios and 95% confidence intervals (CIs) were estimated with Poisson regression. Significance of trends in age-adjusted admission rates were tested with generalized linear regression. Models were stratified by calendar period to identify shifts in MICU admission risk over time.

RESULTS:

Compared to HIV-/HCV-/ARD- patients, relative risk of MICU admission decreased among HIV-mono-infected patients from 61% (95% CI: 1.56 to 1.65) in 1997-2009% to 21% (95% CI: 1.16 to 1.27) in 2010-2014, increased among HCV-mono-infected patients from 22% (95% CI: 1.16 to 1.29) in 1997-2009% to 54% (95% CI: 1.43 to 1.67) in 2010-2014, and remained consistent among patients with ARD only at 46% (95% CI: 1.42 to 1.50). MICU admission rates decreased by 48% among HCV-uninfected patients (P-trend <0.0001) but did not change among HCV+ patients (P-trend = 0.34).

CONCLUSION:

HCV infection and ARD remain key contributors to MICU admission risk. The impact of each of these conditions could be mitigated with combination of treatment of HIV, HCV, and interventions targeting unhealthy alcohol use.

PMID:
30422912
PMCID:
PMC6701630
[Available on 2020-02-01]
DOI:
10.1097/QAI.0000000000001904

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