PMID- 28469696
OWN - NLM
STAT- MEDLINE
DCOM- 20180319
LR  - 20220318
IS  - 1742-6405 (Electronic)
IS  - 1742-6405 (Linking)
VI  - 14
DP  - 2017
TI  - Hospital days attributable to immune reconstitution inflammatory syndrome in 
      persons living with HIV before and after the 2012 DHHS HIV guidelines.
PG  - 25
LID - 10.1186/s12981-017-0152-0 [doi]
LID - 25
AB  - 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 < 0.001). Median length of stay for IRIS-attributable 
      hospitalizations was longer than for other diagnoses, particularly during Time 
      Period 1 (12.0 vs 4.0; p = 0.05). The most common causes for hospitalizations in 
      PLWH were non AIDS-defining infection, AIDS-defining malignancy, and 
      gastrointestinal. PLWH who had HIV viral suppression (<200 copies/mL) accounted 
      for 34 and 24% of hospitalizations in Time Periods 1 and 2 respectively. 
      CONCLUSIONS: Hospitalizations for PLWH continue at high rates and IRIS is a 
      significant contributing factor. In our single-center study, there was a lower 
      number of IRIS-attributable hospitalizations and IRIS-attributable hospital days 
      in Time Period 2 compared with Time Period 1. The hospital burden of IRIS may 
      decrease over time as more PLWH are started on ART earlier in the course of 
      infection. This study highlights the continued importance of early diagnosis and 
      linkage to care of those infected with HIV, so that morbidity and costs 
      associated with IRIS continue to decline.
FAU - Liu, Peter
AU  - Liu P
AD  - Department of Internal Medicine, University of Virginia, PO Box 801379, 
      Charlottesville, VA 22908 USA. ISNI: 0000 0000 9136 933X. GRID: grid.27755.32
FAU - Dillingham, Rebecca
AU  - Dillingham R
AD  - Division of Infectious Diseases and International Health, University of Virginia, 
      PO Box 801379, Charlottesville, VA 22908 USA. ISNI: 0000 0000 9136 933X. GRID: 
      grid.27755.32
FAU - McManus, Kathleen
AU  - McManus K
AD  - Division of Infectious Diseases and International Health, University of Virginia, 
      PO Box 801379, Charlottesville, VA 22908 USA. ISNI: 0000 0000 9136 933X. GRID: 
      grid.27755.32
LA  - eng
GR  - F32 HS024196/HS/AHRQ HHS/United States
PT  - Journal Article
DEP - 20170502
PL  - England
TA  - AIDS Res Ther
JT  - AIDS research and therapy
JID - 101237921
SB  - IM
EIN - AIDS Res Ther. 2017 May 22;14 :29. PMID: 28539969
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - Female
MH  - HIV Infections/*complications/*drug therapy
MH  - Hospitalization/*trends
MH  - Hospitals/*statistics & numerical data
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*epidemiology
MH  - Male
MH  - Middle Aged
MH  - Practice Guidelines as Topic
MH  - Retrospective Studies
MH  - United States
MH  - United States Dept. of Health and Human Services
MH  - Young Adult
PMC - PMC5414162
OTO - NOTNLM
OT  - AIDS
OT  - Acquired immunodeficiency syndrome
OT  - HIV
OT  - Hospitalization
OT  - Human immunodeficiency virus
OT  - IRIS
OT  - Immune reconstitution inflammatory syndrome
OT  - Practice guidelines
OT  - United States Dept. of Health and Human Services
EDAT- 2017/05/05 06:00
MHDA- 2018/03/20 06:00
PMCR- 2017/05/02
CRDT- 2017/05/05 06:00
PHST- 2017/01/13 00:00 [received]
PHST- 2017/04/26 00:00 [accepted]
PHST- 2017/05/05 06:00 [entrez]
PHST- 2017/05/05 06:00 [pubmed]
PHST- 2018/03/20 06:00 [medline]
PHST- 2017/05/02 00:00 [pmc-release]
AID - 152 [pii]
AID - 10.1186/s12981-017-0152-0 [doi]
PST - epublish
SO  - AIDS Res Ther. 2017 May 2;14:25. doi: 10.1186/s12981-017-0152-0. eCollection 
      2017.