Hospitalization rates and reasons among HIV elite controllers and persons with medically controlled HIV infection

Trevor A. Crowell, Kelly A. Gebo, Joel N. Blankson, Philip (Todd) Korthuis, Baligh R. Yehia, Richard M. Rutstein, Richard D. Moore, Victoria Sharp, Ank E. Nijhawan, W. Christopher Mathews, Lawrence H. Hanau, Roberto B. Corales, Robert Beil, Charurut Somboonwit, Howard Edelstein, Sara L. Allen, Stephen A. Berry

Research output: Contribution to journalArticle

50 Citations (Scopus)

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/mm2 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.

Original languageEnglish (US)
Pages (from-to)1692-1702
Number of pages11
JournalJournal of Infectious Diseases
Volume211
Issue number11
DOIs
StatePublished - Jun 1 2015

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Virus Diseases
Viremia
Hospitalization
HIV
CD4 Lymphocyte Count
Psychiatry
Demography
Confidence Intervals
Inflammation
T-Lymphocytes
Incidence
Infection

Keywords

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

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology and Allergy

Cite this

Hospitalization rates and reasons among HIV elite controllers and persons with medically controlled HIV infection. / Crowell, Trevor A.; Gebo, Kelly A.; Blankson, Joel N.; Korthuis, Philip (Todd); Yehia, Baligh R.; Rutstein, Richard M.; Moore, Richard D.; Sharp, Victoria; Nijhawan, Ank E.; Mathews, W. Christopher; Hanau, Lawrence H.; Corales, Roberto B.; Beil, Robert; Somboonwit, Charurut; Edelstein, Howard; Allen, Sara L.; Berry, Stephen A.

In: Journal of Infectious Diseases, Vol. 211, No. 11, 01.06.2015, p. 1692-1702.

Research output: Contribution to journalArticle

Crowell, TA, Gebo, KA, Blankson, JN, Korthuis, PT, Yehia, BR, Rutstein, RM, Moore, RD, Sharp, V, Nijhawan, AE, Mathews, WC, Hanau, LH, Corales, RB, Beil, R, Somboonwit, C, Edelstein, H, Allen, SL & Berry, SA 2015, 'Hospitalization rates and reasons among HIV elite controllers and persons with medically controlled HIV infection', Journal of Infectious Diseases, vol. 211, no. 11, pp. 1692-1702. https://doi.org/10.1093/infdis/jiu809
Crowell, Trevor A. ; Gebo, Kelly A. ; Blankson, Joel N. ; Korthuis, Philip (Todd) ; Yehia, Baligh R. ; Rutstein, Richard M. ; Moore, Richard D. ; Sharp, Victoria ; Nijhawan, Ank E. ; Mathews, W. Christopher ; Hanau, Lawrence H. ; Corales, Roberto B. ; Beil, Robert ; Somboonwit, Charurut ; Edelstein, Howard ; Allen, Sara L. ; Berry, Stephen A. / Hospitalization rates and reasons among HIV elite controllers and persons with medically controlled HIV infection. In: Journal of Infectious Diseases. 2015 ; Vol. 211, No. 11. pp. 1692-1702.
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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/mm2 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.",
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T1 - Hospitalization rates and reasons among HIV elite controllers and persons with medically controlled HIV infection

AU - Crowell, Trevor A.

AU - Gebo, Kelly A.

AU - Blankson, Joel N.

AU - Korthuis, Philip (Todd)

AU - Yehia, Baligh R.

AU - Rutstein, Richard M.

AU - Moore, Richard D.

AU - Sharp, Victoria

AU - Nijhawan, Ank E.

AU - Mathews, W. Christopher

AU - Hanau, Lawrence H.

AU - Corales, Roberto B.

AU - Beil, Robert

AU - Somboonwit, Charurut

AU - Edelstein, Howard

AU - Allen, Sara L.

AU - Berry, Stephen A.

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N2 - 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/mm2 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.

AB - 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/mm2 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.

KW - antiretroviral therapy

KW - elite control

KW - HIV

KW - hospitalization

KW - inflammation

KW - psychiatric disease

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