Hospital days attributable to immune reconstitution inflammatory syndrome in persons living with HIV before and after th
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Liu et al. AIDS Res Ther (2017) 14:25 DOI 10.1186/s12981-017-0152-0
Open Access
RESEARCH
Hospital days attributable to immune reconstitution inflammatory syndrome in persons living with HIV before and after the 2012 DHHS HIV guidelines Peter Liu1*, Rebecca Dillingham2 and Kathleen A. McManus2
Abstract Background: Immune reconstitution inflammatory syndrome (IRIS) can manifest with initiation or reintroduction of antiretroviral therapy (ART) in persons living with HIV (PLWH). In 2012, updated United States treatment guidelines recommended initiation of ART for all PLWH regardless of CD4 count. The objectives of this study were to quantify hospital usage attributable to IRIS and assess the reasons for hospitalization in PLWH before and after the guideline update. Methods: Subjects were PLWH between 18–89 years of age who were hospitalized between November 1, 2009 and July 31, 2014. Equivalent time periods before and after updated treatment guidelines were considered, and designated as Time Period 1 and Time Period 2, respectively. IRIS-attributable hospitalizations were identified by ICD9 codes and electronic medical record searches with subsequent review and confirmation. For hospitalizations that were not confirmed as being IRIS-attributable, primary discharge diagnoses were reviewed. Results: A total of 278 PLWH were hospitalized 521 times throughout the study period. Time Period 1 had 9 PLWH with 12 IRIS-attributable hospitalizations while Time Period 2 had 6 PLWH with 9 IRIS-attributable hospitalizations. A larger proportion of IRIS-attributable hospital days was observed in Time Period 1 compared to Time Period 2 (7.5 vs 4.2%; p 1000
88 (58)
No exposure or infection
6 (67)
1 (11)
Time Period 1: 154 had a CD4 cell count measured, Time Period 2: 113 had a CD4 cell count measured
Time Period 1: 148 had HCV serologies measured, Time Period 2: 108 had HCV serologies measured
e
Time Period 1: 146 had HBV serologies measured, Time Period 2: 108 had HBV serologies measured
Time Period 1: 154 had a HIV Viral Load measured, Time Period 2: 113 had a HIV Viral Load measured
d
c
99 (66)
No exposure or infection
1 (11)
5 (56)
1 (11)
2 (22)
5 (56)
0 (0)
4 (44)
0 (0)
1 (11)
8 (89)
1(11)
1 (11)
5 (56)
2 (22)
2 (22)
7 (78)
42.8
9
Subjects with Time Period 1 IRIS-attributable hospitalization n (%)
In our health system, subjects self-identify as male or female. This information is recorded in the electronic health record
b
a
10 (7)
Exposure and clearance 51 (18)
189 (68)
31 (21)
16 (6)
Chronic infection
Hepatitis C co-infectione
35 (23)
Exposure and clearance 33 (12)
162 (58)
15 (10)
49 (32)
7 (5)
89 (59)
39 (26)
47 (31)
59 (39)
2 (1)
4 (3)
84 (56)
61 (40)
46 (30)
105 (70)
47.7
151
59 (21)
Chronic infection
Hepatitis B co-infectiond
154 (55)
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