Current and Past Immunodeficiency Are Associated with Higher Hospitalization Rates among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years

Thibaut Davy-Mendez; Sonia Napravnik; Joseph J. Eron; Stephen R. Cole; David Van Duin; David A. Wohl; Brenna C. Hogan; Keri N. Althoff; Kelly A. Gebo; Richard D. Moore; Michael J. Silverberg; Michael A. Horberg; M. John Gill; W. Christopher Mathews; Marina B. Klein; Jonathan A. Colasanti; Timothy R. Sterling; Angel M. Mayor; Peter F. Rebeiro; Kate Buchacz; Jun Li; Ni Gusti Ayu Nanditha; Jennifer E. Thorne; Ank Nijhawan; Stephen A. Berry; Constance A. Benson; Ronald J. Bosch; Gregory D. Kirk; Kenneth H. Mayer; Chris Grasso; Robert S. Hogg; Julio S.G. Montaner; Kate Salters; Viviane D. Lima; Paul Sereda; Jason Trigg; Kate Buchacz; Jun Li; Kelly A. Gebo; Benigno Rodriguez; Michael A. Horberg; Michael J. Silverberg; Jennifer E. Thorne; Todd Brown; Phyllis Tien; Gypsyamber D'souza; Charles Rabkin; Abigail Kroch; Ann Burchell; Adrian Betts; oanne Lindsay; Robert F. Hunter-Mellado; Angel M. Mayor; Jeffrey N. Martin; Jun Li; John T. Brooks; Michael S. Saag; Michael J. Mugavero; James Willig; William C. Mathews; Sonia Napravnik; Mari M. Kitahata; Heidi M. Crane; David Haas; Peter Rebeiro; Megan Turner; Janet Tate; Robert Dubrow; David Fiellin; Stephen J. Gange; Mari M. Kitahata; Michael S. Saag; Michael A. Horberg; Rosemary G. Mckaig; Aimee M. Freeman; Mari M. Kitahata; Stephen E. Van Rompaey; Heidi M. Crane; Liz Morton; Justin Mcreynolds; William B. Lober; Stephen J. Gange; Jennifer S. Lee; Bin You; Brenna Hogan; Jinbing Zhang; Jerry Jing; Elizabeth Humes; Lucas Gerace; Sally Coburn

doi:10.1093/infdis/jiaa786

Current and Past Immunodeficiency Are Associated with Higher Hospitalization Rates among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years

Thibaut Davy-Mendez, Sonia Napravnik, Joseph J. Eron, Stephen R. Cole, David Van Duin, David A. Wohl, Brenna C. Hogan, Keri N. Althoff, Kelly A. Gebo, Richard D. Moore, Michael J. Silverberg, Michael A. Horberg, M. John Gill, W. Christopher Mathews, Marina B. Klein, Jonathan A. Colasanti, Timothy R. Sterling, Angel M. Mayor, Peter F. Rebeiro, Kate BuchaczJun Li, Ni Gusti Ayu Nanditha, Jennifer E. Thorne, Ank Nijhawan, Stephen A. Berry, Constance A. Benson, Ronald J. Bosch, Gregory D. Kirk, Kenneth H. Mayer, Chris Grasso, Robert S. Hogg, Julio S.G. Montaner, Kate Salters, Viviane D. Lima, Paul Sereda, Jason Trigg, Kate Buchacz, Jun Li, Kelly A. Gebo, Benigno Rodriguez, Michael A. Horberg, Michael J. Silverberg, Jennifer E. Thorne, Todd Brown, Phyllis Tien, Gypsyamber D'souza, Charles Rabkin, Abigail Kroch, Ann Burchell, Adrian Betts, oanne Lindsay, Robert F. Hunter-Mellado, Angel M. Mayor, Jeffrey N. Martin, Jun Li, John T. Brooks, Michael S. Saag, Michael J. Mugavero, James Willig, William C. Mathews, Sonia Napravnik, Mari M. Kitahata, Heidi M. Crane, David Haas, Peter Rebeiro, Megan Turner, Janet Tate, Robert Dubrow, David Fiellin, Stephen J. Gange, Mari M. Kitahata, Michael S. Saag, Michael A. Horberg, Rosemary G. Mckaig, Aimee M. Freeman, Mari M. Kitahata, Stephen E. Van Rompaey, Heidi M. Crane, Liz Morton, Justin Mcreynolds, William B. Lober, Stephen J. Gange, Jennifer S. Lee, Bin You, Brenna Hogan, Jinbing Zhang, Jerry Jing, Elizabeth Humes, Lucas Gerace, Sally Coburn

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Persons with human immunodeficiency virus (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk. Methods: In 6 US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (years 2-5) and long-term (years 6-11) suppression and lowest presuppression CD4 count <200 and ≥200 cells/μL, Poisson regression models estimated hospitalization incidence rate ratios (aIRRs) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest presuppression CD4 count. Results: The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% white. Among patients with lowest presuppression CD4 count <200 cells/μL (44%), patients with current CD4 count 200-350 vs >500 cells/μL had aIRRs of 1.44 during early suppression (95% confidence interval [CI], 1.01-2.06), and 1.67 (95% CI, 1.03-2.72) during long-term suppression. Among patients with lowest presuppression CD4 count ≥200 (56%), patients with current CD4 351-500 vs >500 cells/μL had an aIRR of 1.22 (95% CI,. 93-1.60) during early suppression and 2.09 (95% CI, 1.18-3.70) during long-term suppression. Conclusions: Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates and could potentially benefit from targeted clinical management strategies.

Original language	English (US)
Pages (from-to)	657-666
Number of pages	10
Journal	Journal of Infectious Diseases
Volume	224
Issue number	4
DOIs	https://doi.org/10.1093/infdis/jiaa786
State	Published - Aug 15 2021

Keywords

CD4 lymphocyte count
HIV
cohort studies
hospitalization
sustained virologic response

ASJC Scopus subject areas

General Medicine

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10.1093/infdis/jiaa786

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Davy-Mendez, T., Napravnik, S., Eron, J. J., Cole, S. R., Van Duin, D., Wohl, D. A., Hogan, B. C., Althoff, K. N., Gebo, K. A., Moore, R. D., Silverberg, M. J., Horberg, M. A., Gill, M. J., Mathews, W. C., Klein, M. B., Colasanti, J. A., Sterling, T. R., Mayor, A. M., Rebeiro, P. F., ... Coburn, S. (2021). Current and Past Immunodeficiency Are Associated with Higher Hospitalization Rates among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years. Journal of Infectious Diseases, 224(4), 657-666. https://doi.org/10.1093/infdis/jiaa786

Current and Past Immunodeficiency Are Associated with Higher Hospitalization Rates among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years. / Davy-Mendez, Thibaut; Napravnik, Sonia; Eron, Joseph J. et al.
In: Journal of Infectious Diseases, Vol. 224, No. 4, 15.08.2021, p. 657-666.

Research output: Contribution to journal › Article › peer-review

Davy-Mendez, T, Napravnik, S, Eron, JJ, Cole, SR, Van Duin, D, Wohl, DA, Hogan, BC, Althoff, KN , Gebo, KA , Moore, RD, Silverberg, MJ, Horberg, MA, Gill, MJ, Mathews, WC, Klein, MB, Colasanti, JA, Sterling, TR, Mayor, AM, Rebeiro, PF, Buchacz, K, Li, J, Nanditha, NGA, Thorne, JE, Nijhawan, A, Berry, SA, Benson, CA, Bosch, RJ, Kirk, GD, Mayer, KH, Grasso, C, Hogg, RS, Montaner, JSG, Salters, K, Lima, VD, Sereda, P, Trigg, J, Buchacz, K, Li, J, Gebo, KA, Rodriguez, B, Horberg, MA, Silverberg, MJ, Thorne, JE, Brown, T, Tien, P, D'souza, G, Rabkin, C, Kroch, A, Burchell, A, Betts, A, Lindsay, O, Hunter-Mellado, RF, Mayor, AM, Martin, JN, Li, J, Brooks, JT, Saag, MS, Mugavero, MJ, Willig, J, Mathews, WC, Napravnik, S, Kitahata, MM, Crane, HM, Haas, D, Rebeiro, P, Turner, M, Tate, J, Dubrow, R, Fiellin, D, Gange, SJ, Kitahata, MM, Saag, MS, Horberg, MA, Mckaig, RG, Freeman, AM, Kitahata, MM, Van Rompaey, SE, Crane, HM, Morton, L, Mcreynolds, J, Lober, WB, Gange, SJ , Lee, JS, You, B, Hogan, B, Zhang, J, Jing, J, Humes, E, Gerace, L & Coburn, S 2021, 'Current and Past Immunodeficiency Are Associated with Higher Hospitalization Rates among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years', Journal of Infectious Diseases, vol. 224, no. 4, pp. 657-666. https://doi.org/10.1093/infdis/jiaa786

@article{e745f0933a3c4f4e85c21e1d73ce03ff,

title = "Current and Past Immunodeficiency Are Associated with Higher Hospitalization Rates among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years",

abstract = "Background: Persons with human immunodeficiency virus (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk. Methods: In 6 US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (years 2-5) and long-term (years 6-11) suppression and lowest presuppression CD4 count <200 and ≥200 cells/μL, Poisson regression models estimated hospitalization incidence rate ratios (aIRRs) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest presuppression CD4 count. Results: The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% white. Among patients with lowest presuppression CD4 count <200 cells/μL (44%), patients with current CD4 count 200-350 vs >500 cells/μL had aIRRs of 1.44 during early suppression (95% confidence interval [CI], 1.01-2.06), and 1.67 (95% CI, 1.03-2.72) during long-term suppression. Among patients with lowest presuppression CD4 count ≥200 (56%), patients with current CD4 351-500 vs >500 cells/μL had an aIRR of 1.22 (95% CI,. 93-1.60) during early suppression and 2.09 (95% CI, 1.18-3.70) during long-term suppression. Conclusions: Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates and could potentially benefit from targeted clinical management strategies.",

keywords = "CD4 lymphocyte count, HIV, cohort studies, hospitalization, sustained virologic response",

author = "Thibaut Davy-Mendez and Sonia Napravnik and Eron, {Joseph J.} and Cole, {Stephen R.} and {Van Duin}, David and Wohl, {David A.} and Hogan, {Brenna C.} and Althoff, {Keri N.} and Gebo, {Kelly A.} and Moore, {Richard D.} and Silverberg, {Michael J.} and Horberg, {Michael A.} and Gill, {M. John} and Mathews, {W. Christopher} and Klein, {Marina B.} and Colasanti, {Jonathan A.} and Sterling, {Timothy R.} and Mayor, {Angel M.} and Rebeiro, {Peter F.} and Kate Buchacz and Jun Li and Nanditha, {Ni Gusti Ayu} and Thorne, {Jennifer E.} and Ank Nijhawan and Berry, {Stephen A.} and Benson, {Constance A.} and Bosch, {Ronald J.} and Kirk, {Gregory D.} and Mayer, {Kenneth H.} and Chris Grasso and Hogg, {Robert S.} and Montaner, {Julio S.G.} and Kate Salters and Lima, {Viviane D.} and Paul Sereda and Jason Trigg and Kate Buchacz and Jun Li and Gebo, {Kelly A.} and Benigno Rodriguez and Horberg, {Michael A.} and Silverberg, {Michael J.} and Thorne, {Jennifer E.} and Todd Brown and Phyllis Tien and Gypsyamber D'souza and Charles Rabkin and Abigail Kroch and Ann Burchell and Adrian Betts and oanne Lindsay and Hunter-Mellado, {Robert F.} and Mayor, {Angel M.} and Martin, {Jeffrey N.} and Jun Li and Brooks, {John T.} and Saag, {Michael S.} and Mugavero, {Michael J.} and James Willig and Mathews, {William C.} and Sonia Napravnik and Kitahata, {Mari M.} and Crane, {Heidi M.} and David Haas and Peter Rebeiro and Megan Turner and Janet Tate and Robert Dubrow and David Fiellin and Gange, {Stephen J.} and Kitahata, {Mari M.} and Saag, {Michael S.} and Horberg, {Michael A.} and Mckaig, {Rosemary G.} and Freeman, {Aimee M.} and Kitahata, {Mari M.} and {Van Rompaey}, {Stephen E.} and Crane, {Heidi M.} and Liz Morton and Justin Mcreynolds and Lober, {William B.} and Gange, {Stephen J.} and Lee, {Jennifer S.} and Bin You and Brenna Hogan and Jinbing Zhang and Jerry Jing and Elizabeth Humes and Lucas Gerace and Sally Coburn",

note = "Publisher Copyright: {\textcopyright} 2020 The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].",

year = "2021",

month = aug,

day = "15",

doi = "10.1093/infdis/jiaa786",

language = "English (US)",

volume = "224",

pages = "657--666",

journal = "Journal of Infectious Diseases",

issn = "0022-1899",

publisher = "Oxford University Press",

number = "4",

}

TY - JOUR

T1 - Current and Past Immunodeficiency Are Associated with Higher Hospitalization Rates among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years

AU - Davy-Mendez, Thibaut

AU - Napravnik, Sonia

AU - Eron, Joseph J.

AU - Cole, Stephen R.

AU - Van Duin, David

AU - Wohl, David A.

AU - Hogan, Brenna C.

AU - Althoff, Keri N.

AU - Gebo, Kelly A.

AU - Moore, Richard D.

AU - Silverberg, Michael J.

AU - Horberg, Michael A.

AU - Gill, M. John

AU - Mathews, W. Christopher

AU - Klein, Marina B.

AU - Colasanti, Jonathan A.

AU - Sterling, Timothy R.

AU - Mayor, Angel M.

AU - Rebeiro, Peter F.

AU - Buchacz, Kate

AU - Li, Jun

AU - Nanditha, Ni Gusti Ayu

AU - Thorne, Jennifer E.

AU - Nijhawan, Ank

AU - Berry, Stephen A.

AU - Benson, Constance A.

AU - Bosch, Ronald J.

AU - Kirk, Gregory D.

AU - Mayer, Kenneth H.

AU - Grasso, Chris

AU - Hogg, Robert S.

AU - Montaner, Julio S.G.

AU - Salters, Kate

AU - Lima, Viviane D.

AU - Sereda, Paul

AU - Trigg, Jason

AU - Buchacz, Kate

AU - Li, Jun

AU - Gebo, Kelly A.

AU - Rodriguez, Benigno

AU - Horberg, Michael A.

AU - Silverberg, Michael J.

AU - Thorne, Jennifer E.

AU - Brown, Todd

AU - Tien, Phyllis

AU - D'souza, Gypsyamber

AU - Rabkin, Charles

AU - Kroch, Abigail

AU - Burchell, Ann

AU - Betts, Adrian

AU - Lindsay, oanne

AU - Hunter-Mellado, Robert F.

AU - Mayor, Angel M.

AU - Martin, Jeffrey N.

AU - Li, Jun

AU - Brooks, John T.

AU - Saag, Michael S.

AU - Mugavero, Michael J.

AU - Willig, James

AU - Mathews, William C.

AU - Napravnik, Sonia

AU - Kitahata, Mari M.

AU - Crane, Heidi M.

AU - Haas, David

AU - Rebeiro, Peter

AU - Turner, Megan

AU - Tate, Janet

AU - Dubrow, Robert

AU - Fiellin, David

AU - Gange, Stephen J.

AU - Kitahata, Mari M.

AU - Saag, Michael S.

AU - Horberg, Michael A.

AU - Mckaig, Rosemary G.

AU - Freeman, Aimee M.

AU - Kitahata, Mari M.

AU - Van Rompaey, Stephen E.

AU - Crane, Heidi M.

AU - Morton, Liz

AU - Mcreynolds, Justin

AU - Lober, William B.

AU - Gange, Stephen J.

AU - Lee, Jennifer S.

AU - You, Bin

AU - Hogan, Brenna

AU - Zhang, Jinbing

AU - Jing, Jerry

AU - Humes, Elizabeth

AU - Gerace, Lucas

AU - Coburn, Sally

N1 - Publisher Copyright: © 2020 The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

PY - 2021/8/15

Y1 - 2021/8/15

N2 - Background: Persons with human immunodeficiency virus (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk. Methods: In 6 US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (years 2-5) and long-term (years 6-11) suppression and lowest presuppression CD4 count <200 and ≥200 cells/μL, Poisson regression models estimated hospitalization incidence rate ratios (aIRRs) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest presuppression CD4 count. Results: The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% white. Among patients with lowest presuppression CD4 count <200 cells/μL (44%), patients with current CD4 count 200-350 vs >500 cells/μL had aIRRs of 1.44 during early suppression (95% confidence interval [CI], 1.01-2.06), and 1.67 (95% CI, 1.03-2.72) during long-term suppression. Among patients with lowest presuppression CD4 count ≥200 (56%), patients with current CD4 351-500 vs >500 cells/μL had an aIRR of 1.22 (95% CI,. 93-1.60) during early suppression and 2.09 (95% CI, 1.18-3.70) during long-term suppression. Conclusions: Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates and could potentially benefit from targeted clinical management strategies.

AB - Background: Persons with human immunodeficiency virus (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk. Methods: In 6 US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (years 2-5) and long-term (years 6-11) suppression and lowest presuppression CD4 count <200 and ≥200 cells/μL, Poisson regression models estimated hospitalization incidence rate ratios (aIRRs) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest presuppression CD4 count. Results: The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% white. Among patients with lowest presuppression CD4 count <200 cells/μL (44%), patients with current CD4 count 200-350 vs >500 cells/μL had aIRRs of 1.44 during early suppression (95% confidence interval [CI], 1.01-2.06), and 1.67 (95% CI, 1.03-2.72) during long-term suppression. Among patients with lowest presuppression CD4 count ≥200 (56%), patients with current CD4 351-500 vs >500 cells/μL had an aIRR of 1.22 (95% CI,. 93-1.60) during early suppression and 2.09 (95% CI, 1.18-3.70) during long-term suppression. Conclusions: Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates and could potentially benefit from targeted clinical management strategies.

KW - CD4 lymphocyte count

KW - HIV

KW - cohort studies

KW - hospitalization

KW - sustained virologic response

UR - http://www.scopus.com/inward/record.url?scp=85106034087&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85106034087&partnerID=8YFLogxK

U2 - 10.1093/infdis/jiaa786

DO - 10.1093/infdis/jiaa786

M3 - Article

C2 - 34398239

AN - SCOPUS:85106034087

SN - 0022-1899

VL - 224

SP - 657

EP - 666

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

IS - 4

ER -

Current and Past Immunodeficiency Are Associated with Higher Hospitalization Rates among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years

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