Readmission or Death Follows Hospital Discharge for Almost 1 in 3 Patients With HIV

Nearly one third of patients with human immunodeficiency virus (HIV) discharged from the hospital over the past 15 years subsequently experienced readmission or death, according to a systematic review and meta-analysis published in The Lancet HIV.

“The majority of adverse outcomes occurred within 30 days following discharge,” researchers wrote, “but the proportion of patients who had an adverse outcome overall was higher in studies that followed up patients for longer durations.”

Researchers looked at outcomes among people with HIV after hospital discharge in 29 studies published between 2003, when scale-up of antiretroviral therapy began in low-income countries, and 2021. More than 92,000 patients hospitalized with HIV were included.

According to the findings, the pooled proportion of patients readmitted after hospital discharge was 18.8%; 14.1% died after hospital discharge. A comparison of studies published before and after 2016, when universal antiretroviral therapy was recommended, showed no differences in the rate of post-discharge readmissions or deaths.

Compared with 7.5% postdischarge mortality in US studies, studies from Africa showed a 23.1% postdischarge mortality rate. Studies that followed patients for longer than 30 days had even higher rates of postdischarge mortality.

In 11 studies that reported both postdischarge mortality and readmission, the pooled proportion of patients who had the composite adverse outcome was 31.7%.

Risk factors for readmission included low CD4 cell count at admission, longer length of stay, not being on antiretroviral therapy, discharge against medical advice, and not linking to care after discharge, researchers reported. Meanwhile, treatment with antiretroviral therapy during hospitalization protected against mortality after discharge.

“These findings emphasize the need for continued efforts to ensure that all people with HIV are taking antiretroviral therapy and that better support is provided for postdischarge referral and appropriate postdischarge linkage and management, particularly for individuals with low CD4 cell counts at discharge,” the authors advised.

Reference:
Ford N, Patten G, Rangaraj A, Davies MA, Meintjes G, Ellman T. Outcomes of people living with HIV after hospital discharge: a systematic review and meta-analysis. Lancet HIV. 2022;9(3):e150-e159. doi:10.1016/S2352-3018(21)00329-5