DISPARITIES IN HOSPITALIZATION RATES AMONG PERSONS WITH HIV IN THE UNITED STATES AND CANADA BETWEEN 2005 AND 2015

Increased antiretroviral therapy (ART) use with potent regimens has increased virologic suppression and life expectancy among persons with HIV (PWH) and might have affected hospitalization rates among different sub-groups of PWH. Among PWH in care in six clinical cohorts in the United States (US) and Canada 2005–2015, we examined (1) racial/ethnic and gender disparities in hospitalization rates, and (2) associations between CD4 cell count and hospitalizations across years of virologic suppression. We used Poisson regression models with robust variances to estimate incidence rate ratios (IRR). Of 27,085 patients (122,566 person-years), 80% were cisgender men, 1% transgender, 43% White, 33% Black, 17% Hispanic, and 1% Indigenous. Unadjusted all-cause hospitalization rates were higher for Black (IRR 1.46, 95% CI 1.32-1.61) and Indigenous (1.99, 1.44-2.74) versus White cisgender men, and for Indigenous versus White cisgender women (2.55, 1.68-3.89). Unadjusted AIDS-related hospitalization rates were also higher for Black, Hispanic, and Indigenous versus White cisgender men (all P500 had an adjusted IRR of hospitalization of 1.44 during suppression years 2–5 (95% CI 1.01, 2.06), and 1.67 (1.03, 2.72) during years 6–11. Among patients whose lowest pre-suppression CD4 was ≥200 (56%), during suppression years 6–11, for patients whose current CD4 count 351–500 versus >500, the adjusted hospitalization IRR was 2.09 (1.18, 3.70). Black, Indigenous, women, and transgender PWH in the US and Canada experienced substantially higher hospitalization rates than White patients and cisgender men. Contributors likely include differences in virologic suppression and chronic conditions (e.g. diabetes and renal disease). Among PWH on ART for up to 11 years, patients whose CD4 counts remained lower experienced higher hospitalization rates, even without a history of severe immunodeficiency.Doctor of Philosoph