Presenting With AIDS at Diagnosis Is Associated With 24-Month Viral Suppression in Patients Newly Diagnosed With HIV During Hospitalization at an Urban Hospital Center

Background. HIV testing during hospitalization has been recommended by CDC for many years yet little is known about the outcomes of patients diagnosed in the hospital. We aimed to characterize patient-level and system-level factors associated with long-term viral suppression (VS) following an inpatient HIV diagnosis.

Methods. Retrospective cohort study in patients newly diagnosed during hospitalization at Grady Memorial Hospital in Atlanta, Georgia from January 2011 to December 2012. Data were abstracted from medical records and the Georgia Department of Public Health Enhanced HIV/AIDS Surveillance System (eHARS) for 24 months following the diagnosis. Primary outcome was 24-month VS, defined as the last HIV-1 RNA of each 12-month period after diagnosis being <200 copies/mL. Variables with significance (p <0.05) by univariate analyses and epidemiologically significant factors were included in a backward multivariate logistic regression analysis.

Results. One hundred thirty-two patients were newly diagnosed during the study period. Median age was 41 (IQR 31, 51), 77% men, 77% non-Hispanic Black, 75% uninsured, 18% homeless, and 13% crack/cocaine users. At diagnosis the median CD4 was 83 cells/µL (IQR 18, 264), 42% had an AIDS-defining opportunistic infection (OI) and 70% had AIDS (CD4 <200 cell/µL or presence of an OI). 46% linked to the same healthcare system outpatient clinic (IDP) and 24% linked elsewhere in GA (by state laboratories) within 90 days of hospital discharge. Forty-nine (37%) patients achieved 24-month VS. In univariate analyses, AIDS and being a man who had sex with men (MSM) were associated with 24-month VS while age ≥50 and cocaine use were significantly associated with not achieving 24-month VS. In a multivariate analysis having AIDS (OR 3.93, 95% CI 1.43-10.76) and being MSM (OR 2.58, 95% CI 1.08-6.18) remained significant and were associated with 24-month VS.

Conclusion. Most patients with new diagnoses during hospitalization still present with advanced HIV. AIDS at diagnosis was most strongly associated with achieving long-term VS for two years after inpatient diagnoses. These data suggest that patients have better virologic outcomes when they are diagnosed with advanced HIV, which may be mediated by their eligibility for a Ryan White funded clinic (IDP) with robust wrap around services and/or by patients' perception of their own illness.

Disclosures. C. Del Rio, IAS-USA: Board Member, Volunteer Board member

Author notes