A new nationwide study published in eClinicalMedicine has found that people living with HIV in the U.S. have a significantly higher risk of being readmitted to the hospital within 30 days of discharge compared to people without HIV. The study, which analyzed data on 24,338,782 index admissions from 18,240,176 individuals in the 2019 Nationwide Readmissions Database, is one of the first to comprehensively compare readmission rates between people living with HIV and those without the virus in the era of widespread antiretroviral therapy use.
The researchers found that 20.9% of people living with HIV (PWH) were readmitted to the hospital within 30 days, compared to just 12.2% of people without HIV (PWoH). After adjusting for age, PWH had an 88% higher risk of readmission. This disparity persisted across all sociodemographic, clinical, and diagnostic subgroups examined in the study. In a multivariate analysis adjusting for patient and hospital characteristics, HIV status remained independently associated with higher readmission risk.
Notably, the readmission risk was high across all age groups for PWH, while for PWoH it increased with age from 5.9% for those aged 18-29 to 14.7% for those 80 and older. The risk was especially high among young PWH, with those aged 18-29 having a more than threefold higher risk compared to young PWoH. The study also found that the excess readmission risk for PWH was greater among females than males, with the disparity being particularly large for females under 40, even after excluding pregnancy-related admissions.
PWH who were admitted to the hospital due to exacerbations of chronic heart and kidney diseases had a particularly high risk of readmission, with more than 1 in 3 being readmitted within 30 days. Interestingly, only 3.2% of index admissions among PWH were due to AIDS-defining illnesses, lower than in studies from the early 2000s, suggesting improved antiretroviral therapy coverage and viral control over the past two decades. However, the authors suggest that as PWH live longer, the prevalence of age-related chronic comorbidities will likely increase, potentially leading to an even higher readmission burden in the future.
The researchers note that future studies are needed to evaluate the preventability and driving reasons for readmission among PWH. However, they stress that their findings underscore the importance of long-term ART and viral suppression, as well as the need for HIV care models to ensure access to both HIV care and subspecialty care to optimally manage common comorbid conditions.
The authors declared having no competing interests.