GI Disorders Linked to Higher Costs, Hospitalizations Among Patients Living With HIV

Results from a 5-year study show significantly higher rates of several gastrointestinal (GI) disorders, as well as hospital-related costs, among patients living with HIV compared with controls, reports a study published in The American Journal of Gastroenterology.

“Gastrointestinal disorders are common in patients with [HIV], but data are limited about their prevalence in the hospital setting,” noted the authors. Their study aimed to clarify outcomes among these patients vs age- and sex-matched controls who did not have HIV.

Data for January 2010 to September 2015 were supplied from the Nationwide Readmission Database; International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to classify GI disorders; and multivariable regression models compared total hospital costs and 30-day readmissions.

The 3 primary outcomes were prevalence of GI disorders, cost of care, and 30-day readmission among hospitalized patients who have HIV. The 2 study groups comprised 276,809 individuals living with HIV and 830,427 randomized controls, for a 1:3 ratio.

The most common diagnosed GI disorders in the HIV cohort were diarrhea (8.2%; n = 22,748), abdominal pain (6.2%; n = 17,205), constipation (4.7%; n = 12,909), dysphagia (11,710; n = 11,710), and nausea/vomiting (3.5%; n = 9555). In the matched controls, the most common GI disorders were abdominal pain (4.0%; n = 33,153) and constipation (3.6%; n = 30,118). The least common in both groups were cholangitis, biliary obstruction, and cholecystitis, all occurring in 0.2% each.

Results also show that the highest mean cost differences were seen in the following conditions for the HIV vs the non-HIV groups:

• Inflammatory bowel disease: $30,970 vs $16,702
• Biliary obstruction: $35,393 vs $22,564
• Lower GI bleed: $38,396 vs $25,024
• GI bleed: $37,212 vs $23,683
• Upper GI bleed: $$37,392 vs $23,459

The only GI condition for which patients living with HIV paid less was dysphagia ($19,457 vs $25,530), despite it being more common among them.

Also in the HIV cohort, the highest rates of 30-day readmissions were for chronic pancreatitis and Clostridium difficile infections (38.5% each), abdominal pain (32.0%), and lower GI bleed (31.4%). Among the matched controls, the comparable rates were 30.7%, 25.0%, 21.0%, and 21.0%, respectively.

Overall, 30-day readmission odds were highest for the patients living with HIV for all of the GI conditions identified, with the top 3 being the following:

• Cholecystitis (adjusted odds ratio [aOR], 5.85; 95% CI, 4.09-8.32)
• Cholelithiasis/choledocholithiasis (aOR, 5.72; 95% CI, 5.0-6.54)
• Acute pancreatitis (aOR, 3.39; 95% CI, 3.11-3.70)

“Compared to non-HIV controls, hospitalized HIV patients have a significantly higher prevalence of GI disorders and symptoms, and significantly higher hospital costs for GI disease-related hospitalizations,” the authors concluded. “In order to decrease the prevalence and healthcare costs of GI disorders in hospitalized HIV patients, continued efforts should emphasize the primary treatment of HIV, with a special focus on GI disease with the highest disease burden.”

Reference

Dalsania RM, Nustas R, Patnana S, Brown JM, Qayed ES. Prevalence of gastrointestinal disorders and their healthcare burden in hospitalized HIV patients in the United States. Am J Gastroenterol. 2020;115(suppl 1):S640.