Highly active antiretroviral therapy and hospital readmission: comparison of a matched cohort

BMC Infectious Diseases

Aslam H Anis¹  Anita Palepu³  Xin Li¹  Huiying Sun²  Bohdan Nosyk² 

[1] Department of Healthcare and Epidemiology, University of British Columbia, Vancouver, BC, Canada;Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada;Department of Medicine, University of British Columbia, Vancouver, BC, Canada

Others  :  1176783
DOI  :  10.1186/1471-2334-6-146

 received in 2006-05-05, accepted in 2006-10-05,  发布年份 2006

【 摘 要 】

Background

Despite the known efficacy of highly active antiretroviral therapy (HAART), a large proportion of potentially-eligible HIV-infected patients do not access, and may stand to benefit from this treatment. In order to quantify these benefits in terms of reductions in hospitalizations and hospitalization costs, we sought to determine the impact of HAART on hospital readmission among HIV-infected patients hospitalized at St. Paul's Hospital (SPH) in Vancouver, BC, Canada.

Methods

All patients admitted to a specialized HIV/AIDS ward at SPH (Apr. 1997 – Oct. 2002) were selected and classified as being on HAART or not on HAART based upon their initial admission. Patients were then matched by their propensity scores, which were calculated based on patients' sociodemographics such as age, gender, injection drug use (IDU) status, and AIDS indication, and followed up for one year. Multivariate logistic regression was used to estimate the difference in the odds of hospital readmission between patients on and not on HAART.

Results

Out of a total 1084 patients admitted to the HIV/AIDS ward between 1997 and 2002, 662 were matched according to their propensity score; 331 patients each on and not on HAART. Multivariate logistic regression revealed that patients on HAART had lower odds of AIDS hospital readmission (OR, 0.61; 95% CI, 0.42 – 0.89) compared to patients not on HAART. Odds of readmission among patients on HAART were also significantly lower for non-IDU related readmission (OR, 0.73; 95% CI, 0.53 – 0.99) and overall readmission (OR, 0.72; 95% CI, 0.53 – 0.98).

Conclusion

Propensity score matching allowed us to reliably estimate the association between exposure (on or not on HAART) and outcome (readmitted to hospital). We found that HIV-infected patients who were potentially eligible for, but not on HAART had higher odds of being readmitted to hospital compared to those on HAART. Given the low level of uptake (31%) of HAART observed in our pre-matched hospitalized cohort, a large potential to achieve clinical benefits, reduce hospitalization costs and possibly slow disease progression from improved HAART uptake still exists.

【 授权许可】

   
2006 Nosyk et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Palepu A, Horton NJ, Tibbetts N, Meli S, Samet JH: Uptake and adherence to highly active antiretroviral therapy among HIV-infected people with alcohol and other substance use problems: the impact of substance abuse treatment. Addiction 2004, 99(3):361-8.
• [2]Strathdee SA, Palepu A, Cornelisse PG, Yip B, O'Shaughnessy MV, Montaner JS, Schechter MT, Hogg RS: Barriers to use of free antiretroviral therapy in injection drug users. JAMA 1998, 280:547-9.
• [3]CASCADE Collaboration: Changes in the uptake of antiretroviral therapy and survival in people with known duration of HIV infection in Europe: results from CASCADE. HIV Medicine 2000, 1:224-31.
• [4]Muga R, Egea JM, Sanvisens A, Arnal J, Tural C, Tor J, Rey-Joly C: Impact of injecting drug use on the interruption of antiretroviral therapies. J Epidemiol Community Health 2004, 58:286-7.
• [5]Lucas GM, Chaisson RE, Moore RD: Survival in an urban HIV-1 clinic in the era of highly active antiretroviral therapy: a 5-year cohort study. Journal of Acquired Immune Deficiency Syndromes 2003, 33:321-8.
• [6]Lucas GM: Antiretroviral adherence, drug resistance, viral fitness and HIV disease progression: a tangled web is woven. Journal of Antimicrobial Chemotherapy2005; Feb 18.
• [7]Sendi PP, Bucher HC, Harr T, Craig BA, Schweitert M, Pfluger D, Gafni A, Battegay M: Cost-effectiveness of highly active antiretroviral therapy in HIV-infected patients. Swiss HIV Cohort Study AIDS 1999, 13(9):1115-22.
• [8]Miners AH, Sabin CA, Trueman P, Youle M, Mocroft A, Johnson M, Beck EJ: Assessing the cost-effectiveness of highly active antiretroviral therapy for adults with HIV in England. HIV Medicine 2001, 2:52-8.
• [9]Holmes WC: HIV/AIDS, utilities, and cost-effectiveness analysis: stepping toward the future. Med Decis Making 2002, 22(6):522-5.
• [10]Law MG, Li Y, McDonald AM, Cooper DA, Kaldor JM: Estimating the population impact in Australia of improved antiretroviral treatment for HIV infection. AIDS 2000, 14:197-201.
• [11]Moore R: HIV Therapy and prevention: economics and cost-effectiveness. Hopkins HIV Rep 1998, 10(5):10-1.
• [12]Grant RW, Charlebois ED, Wachter RM: Risk factors for early hospital readmission in patients with AIDS and pneumonia. J Gen Intern Med 1999, 14:531-6.
• [13]Palepu A, Sun H, Kuyper L, Schechter MT, O'Shaughnessy MV, Anis AH: Early hospital readmission in HIV-infected patients. J Gen Intern med 2003, 18:242-7.
• [14]Goldberg M, Graves J: The Greater Vancouver Regional District: On our streets and in our shelters: Results of the 2005 Greater Vancouver Homeless Count. [http://www.gvrd.bc.ca/homelessness/research.htm] webcite 2005.
• [15]D'Agostino RB: Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Statist Med 1998, 17:2265-81.
• [16]Elad Y, French WJ, Shavelle DM, Parsons LS, Sada MJ, Every NR: Primary angioplasty and selection bias in patients presenting late (> 12 h) after onset of chest pain and ST elevation myocardial infarction. Journal of the American College of Cardiology 2002, 39(5):826-33.
• [17]Joffe MM, Rosenbaum PR: Invited Commentary: Propensity Scores. American Journal of Epidemiology 1999, 150(4):327-3.
• [18]Ezzy DM, Bartos MR, O de Visser R, Rosenthal DA: Antiretroviral uptake in Australia: medical, attitudinal and cultural correlates. International Journal of STD and AIDS 1998, 9:579-86.
• [19]Palepu A, Yip B, Miller C, Strathdee SA, O'Shaughnessy MV, Montaner JSG, Hogg RS: Factors associated with the response to antiretroviral therapy among HIV-infected patients with and without a history of injection drug use. AIDS 2001, 15(3):423-4.
• [20]Turner BJ, Laine C, Cosler L, Hauck WW: Health care delivery with Antiretroviral adherence. J Gen Intern Med 2003, 18:248-57.
• [21]Sherer R, Pulvirenti J, Stieglitz K, Narra J, Jasek J, Green L, Moore B, Shott S, Cohen M: Hospitalization in HIV in Chicago. J Int Assoc Physicians AIDS Care (Chic Ill) Winter 2002, 1(1):26-33.
• [22]Casalino E, Wolff M, Ravaud P, Choquet C, Bruneel F, Regnier B: Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit. AIDS 2004, 18:1429-33.
• [23]Bangsberg D, Tulsky JP, Hecht RM, Moss AR: Protease Inhibitors in the Homeless. JAMA 1997, 278:63-65.
• [24]Bini T, Testa L, Chiesa E, et al.: Outcome of a second-line protease inhibitor-containing regimen in patients failing or intolerant of a first highly active antiretroviral therapy. JAIDS 2000, 24:115-22.
• [25]Park-Wyllie LY, Scalera A, Tseng A, Rourke S: High rate of discontinuations of highly active antiretroviral therapy as a result of antiretroviral intolerance in clinical practice: missed opportunities for adherence support? AIDS 2002, 16(7):1084-6.
• [26]Richter R, Micheals M, Carlson B, Coates T: Motivators and Barriers to Use of Combination Therapies in Patients with HIV Disease. In San Francisco: Centre for AIDS Prevention Studies. University of California; 1998.
• [27]Catt S, Stygal J, Catalan J: Acceptance of Zidovudine (AZT) in early HIV disease: the role of health benefits. AIDS Care 1995, 7:229-35.
• [28]Mossar M, Lefevre F, Deutsche J, Wesch J, Glassroth J: Factors predicting compliance with prophylactic treatments among HIV positive patients. Int Conf AIDS 1993, 9(2):787. (abstract no. PO-D01-3418).
• [29]Rothman KJ, Greenland S: Modern Epidemiology. 2nd edition. Lippincott-Raven Publishers Philadelphia; 1998:155-7.