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Trends in Hospital Readmission Rates Among HIV Patients: A NA-ACCORD Consortium Study

A decrease in hospital readmission rates among HIV patients is evident, likely attributable to expanded access to antiretroviral therapy and significant advancements in regimens, as concluded from a study published in The Journal of Infectious Diseases. Historically, hospital readmissions have been notably higher with the HIV patient population compared to the general public, making their reduction a primary focus of healthcare policies.

In establishing recent trends in HIV-related hospital readmissions, researchers sourced data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) consortium. The data involved 8,823 patients who had a hospital discharge between 2005 and 2018 without a preceding discharge in the past 30 days. Readmission within 30 days from the last hospitalization discharge served as the primary outcome. Several covariates including gender, ethnicity, age, potential risk factors for HIV transmission, CD4+ count, viral load, history of AIDS-defining illness, and participation in the NA-ACCORD cohort were all considered during the study.

It was found that the general probability of readmission dropped from 20.1% in 2005 to 16.3% in 2018. On further consideration of confounders, it was revealed that the absolute rate of readmission has been seeing a yearly decline by 0.19%. Cardiovascular and psychiatric indications both saw reductions in per-year readmissions. Strikingly, 30-day readmissions were common among patients with CD4+ counts under 50, between 50 and 200, and between 201 and 350 cells/µL when compared to the ones with CD4+ counts above 500 cells/µL. Such readmissions were also higher among the patients with a record of AIDS and those aged 60 years and over or between 50 to 59 years as opposed to those aged 40 years and under.

The decline in hospital readmissions among PWH (people with HIV) is attributed to earlier HIV diagnosis, universal ART initiation recommendations, and the application of advanced, effective regimens, which have increased virologic suppression rates and CD4 counts. Though some potential underestimations in readmission rates may have occurred as some patients could have been readmitted to hospitals outside of the medical system from where the data were obtained. The researchers highlighted the ongoing need for efforts in preventing further readmissions in PWHs, specifically those with higher immunodeficiency marked by low CD4 counts, a history of AIDS-defining illness, and unsuppressed viral load.


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