High Burden of AIDS-Defining Conditions and Increased Mortality With Hepatitis Coinfection in HIV-Infected Adults in an Inner City Medical Intensive Care Unit

Abstract

Background. The burden of HIV infection remains high in some regions of the United States, including Baltimore, and is often associated with poor uptake of antire-troviral therapy (ART). AIDS-defining conditions (AIDS-DCs) are frequent, as is co-infection with hepatitis B or C (HBV/HCV). HCV coinfection may increase mortality, including in individuals admitted to the medical intensive care unit (MICU). Here we describe diagnoses and outcomes of HIV-infected patients admitted to the MICU of a large tertiary-care referral hospital and compare mortality in patients with and without hepatitis coinfection and ART use. Methods. We performed a retrospective cohort study of 297 HIV+ patients with first admission to MICU for >24 hours between July 2009 and July 2014. This preliminary analysis includes 113 patients, randomly selected. Data on discharge diagnoses, comorbid conditions, disease severity scores, CD4 cell counts, HIV load (VL), HBV/HCV serology, ART use, and short-and long-term mortality were collected. The relationship between hepatitis coinfection, ART use, qualitative VL, and mortality was analyzed (chi2 test). Results. Of 113 patients, 65% (n = 73) were male, 83% (n = 94) were African American, and the mean age was 44 +/- 12 years. Forty-three patients (38%) had >=1 current AIDS-DC, and 8 patients had 2. The VL was detectable in 82% (median 59,700 copies/mL, interquartile range [IQR] 235,653), and the median CD4 was 64 cells/mm3 (IQR 173). 53% (n = 60) were not receiving ART while in the MICU, of which 68% (n = 41) were not on ART before admission. Fifty-two patients (46%) had positive hepatitis serology (positive anti-HCV and/or anti-HBc and/or HBsAg). MICU mortality was higher in patients with hepatitis coinfection versus HIV monoinfection: 28.9% versus 6.1%, (odds ratio 6.28, 95% confidence interval: 1.33-29.62, P = 0.0105). Significant mortality differences persisted with follow-up to 180 days. There was no difference in outcome by ART use or qualitative VL. Conclusion. Our data reveal a large burden of uncontrolled HIV infection and AIDS in this inner city population with poor ART utilization. Hepatitis coinfection is associated with increased mortality in univariate analysis. The study emphasizes the importance of improved HIV and hepatitis treatment and control. MICU physicians can still expect to diagnose and treat a wide range of AIDS-DCs.