1. Patrick Carr, Colm Bergin, June Craig, Sarah O’Connell
Factors Associated with Admissions in HIV-1 Infected Individuals in the era of multiple HIV Interventions
Patrick Carr, Colm Bergin, June Craig, Sarah O’Connell

2. Background
30% increase in HIV diagnoses reported in Ireland between and 2015[1]
Department of GU Medicine & Infectious Disease SJH
250 new cases in 2014
260 new cases in 2015
Total cohort attending SJH = 2035
2011 audit – 30.8% of HIV+ admissions were attributable to symptomatic HIV infection [2]
Many studies are showing that the trends in HIV admissions are towards more non-AIDS defining admissions since the introduction of combination anti-retroviral therapy (cART).[3][4][5][6]
Ref 1: HPSC data

3. Aims Primary aim Secondary aims
Identify patient factors associated with admissions of HIV positive individuals to SJH, in a 3 month period over 3 years, April – June 2014 to April – June 2016.
Secondary aims
Examine trends of rates of opportunistic infection in those presenting over time
Compare demographics associated with opportunistic infection [OI], HIV-related illness, and HIV-unrelated illness.
Compare demographics over the 3 year time point

4. Methods Single center retrospective cohort study
All HIV-1 infected patients discharged from SJH between April to June, to 2016 respectively were identified
Data was collected via electronic chart records and sorted on a confidential excel database.
Statistical analysis was performed using SPSS version 24. T test for continuous variables and Chi Squared tests for catagorical variables
Engagement in care was defined as at least one HIV care visit over one year preceding date of hospital discharge.
Oppertunistic Infection [OI] was defined as AIDS defining illness
HIV-Related Illness was defined as clinical conditions assoc. with HIV disease but not an OI
HIV-Unrelated Illness was defined as clinical conditions not assoc. with HIV
OI – PCP, TB, CMV, Toxoplasmosis
HIV-Related – sepsis, cellulitis, pyelonephritis
HIV-unrelated – Hip fracture, hypothyroid, removal of JJ stent

5. Results
168 patients with HIV infection were discharged from inpatient care for the months April to June 2014, April –June 2015, and April – June 2016.
2016: 52 patients (28.3%) [Total 2016* – 184 [*Oct]]
2015: 52 patients (21.7%) – [Total 2015 – 240]
2014: 63 patients (25.7%) – [Total 2014 – 245]
28 [17%] patients were admitted twice
3 [2%] patients were admitted 3 times or more.
14 [8%] patients presented as a new diagnosis.
62 [63%] of patients resided outside the SJH catchment area.
3 [2%] patients died during their admission.
23 [14%] patients were readmitted within one month following hospital discharge.

6. Presentation
Total OI 62
HIV - Related 38
HIV - unrelated 67
2014
2015
2016 OI
30 [48%]
18 [35%]
14 [27%]
HIV - Related
16 [25%]
12 [23%]
10 [19%]
HIV - Unrelated
17 [27%]
22 [42%]
28 [54%]
Total 63 52

7. P value – 0.001
P value – 0.009
These differences were found to be statistically significant
Viral load as you would expect in line with the CD4 count
30% of the non-HIV related still had a detectable viral load

8. P value – 0.008
Median Bed Days [LOS]
Median [IQR] length of stay was 7 [3,14] bed days.

9. Engagement in Care
129 [84%] patients engaged in care at the time of admission.
P value - <0.0001
2014
2015
2016
p-value
40 [63%]
45 [85%]
44 [85%]
0.023

10. P value – 0.023
2014
2015
2016
P-value
12 [19%]
12 [23%]
14 [27%]
0.091

11. Hepatitis Co-infection
82 [49%] patients - hepatitis C co-infection
14 [8%] patients - hepatitis B co-infection
P value – <0.001
2014
2015
2016
p-value
Hep C
32 [51%]
26 [49%]
24 [46%]
0.034
Hep B
6 [10%]
6 [11%]
2 [2%]

12. Male
85 [51%] were male
Age
Age range was 24 to 75 years, median [IQR]; 41 [36, 48] years.
2014
2015
2016
Male
36 [57%]
24 [45%]
26 [49%]
2014
2015
2016
p-value
Age 44 43 42
0.040

13. Smoking
104 [62%] patients smokers at time of admission.
Active IVDU
29 [17%] patients actively injecting drugs at the time of admission.
2014
2015
2016
Smoker
38 [60%]
33 [62%]
2014
2015
2016
Active IVDU
11 [17%]
11 [21%]
7 [13%]

14. 2014
2015
2016
p-value
On ARVs
35 [55%]
40 [75%]
43 [83%]
0.008

15. Mode of Acquisition
29 [17%] patients were MSM, 101 [60%] patients were IVDU, 34 [20%] were heterosexual.
P value – 0.016
Proportions for graph
Not looking at % in each group
Out of the OI group – the largest proportion of this group acquired their HIV via IVDU
2014
2015
2016
IVDU
32 [51%]
36 [68%]
33 [63%] HS
17 [27%]
8 [15%]
9 [17%]
MSM
13 [20%]
Other
1 [2%]
2 [2%]

16. Discussion
Percentage of HIV-positive patients presenting with an OI is decreasing over time, while proportion with non-HIV associated illness is increasing.
This trend is reflective of numerous international studies[2][3][4][5]
Those who presented with an OI:
Significantly lower CD4 count and higher HIV-1 viral load
Less likely to be engaged in care.

17. Discussion
IVDU and HCV co-infected individuals were more likely to be admitted for a non-HIV related illness while the heterosexual risk group were more likely to present with OI.
The high percentage of viral load in the non-HIV related admissions is note-worthy [31%] as this is not in line with the total cohort – of whom <10% have a detectable viral load[7]

18. Limitations Retrospective cohort study Time Frame of the project
Retrospective bias
Occasionally missing data
Time Frame of the project
Retrospective bias:
Alcohol excess – reliant on documentation of the doctor
Unemployment – reliant on documentation of the doctor [not always noted if there had been a change in the documentation]
Time Frame:
- Done over the period of one month

19. Conclusion
An improved care package for the IVDU, HCV co- infected cohort needs to be developed to optimise patient care and prevent hospital admissions and healthcare costs.
Need for improved screening and immediate ART given the ongoing rate of opportunistic infections and new diagnoses – especially amongst the heterosexual population.
This project should be extended to look at all admissions over the 3 years and to review this on an annual basis
This project should also be used to compare demographics of the HIV-inpatient population to the demographics of the total HIV+ cohort to gain a better understanding of the characteristics of HIV admissions

20. Acknowledgements
Dr Sarah O’Connell – ID Consultant Department of Genito Urinary Medicine and Infectious Diseases, SJH
Professor Colm Bergin – Consultant Physician, Department of Genito Urinary Medicine and Infectious Diseases, SJH
June Craig – GUIDE Clinic Data Manager, SJH
HIV+ patients whom attend the SJH service

21. References
1 HSE. Health Protection Surveillance Centre. HIV in Ireland, Dublin: Health Protection Surveillance Centre; 2016.
2 Tuite H., Lee K., Bergin C.. (2011) Hospital admissions in HIV-infected patients.
3Hessamfar, M., Colin, C., Bruyand, M., Decoin, M., Bonnet, F., Mercié, P., Neau, D., Cazanave, C., Pellegrin, J., Dabis, F., Morlat, P. and Chêne, G. (2014). Severe Morbidity According to Sex in the Era of Combined Antiretroviral Therapy: The ANRS CO3 Aquitaine Cohort. PLoS ONE, 9(7), p.e
4Greysen, S., Horwitz, L., Covinsky, K., Gordon, K., Ohl, M. and Justice, A. (2013). Does Social Isolation Predict Hospitalization and Mortality Among HIV+ and Uninfected Older Veterans? Journal of the American Geriatrics Society, 61(9), pp
5Lucero, C., Torres, B., León, A., Calvo, M., Leal, L., Pérez, I., Plana, M., Arnedo, M., Mallolas, J., Gatell, J. and García, F. (2013). Rate and Predictors of Non-AIDS Events in a Cohort of HIV-Infected Patients with a CD4 T Cell Count Above 500 Cells/mm 3. AIDS Research and Human Retroviruses, 29(8), pp
6Falster, K., Wand, H., Donovan, B., Anderson, J., Nolan, D., Watson, K., Watson, J. and Law, M. (2010). Hospitalizations in a cohort of HIV patients in Australia, 1999–2007. AIDS, 24(9), pp
7SJH HIV Clinical measures audit (2015)