Prospective Association of Social Circumstance, Socioeconomic, Lifestyle and Mental Health Factors with Subsequent Hospitalisation Over 6-7 Year Follow Up in People Living with HIV

Background: Predictors of hospitalisation in people with HIV (PLHIV) in the contemporary treatment era are not well understood. Methods: This ASTRA questionnaire sub-study used clinic data linkage and medical record review to determine occurrence of hospitalisations among 798 PLHIV from questionnaire completion (2011-2012; baseline) until 1 June 2018. Associations of baseline social circumstance, socioeconomic, lifestyle, mental health, demographic and clinical factors with repeated all-cause hospitalisation were investigated using Prentice-Williams-Peterson models. Associations were also assessed in 461 individuals with CD4 count ≥500 cells/mm3, viral load ≤50 copies/ml, on antiretroviral therapy (ART). Findings: Rate of hospitalisation was 5·8/100 person-years (95% CI: 5·1-6·5). Adjusted for age, demographic group and time with diagnosed HIV, the following factors predicted hospitalisation: no stable partner (aHR=1·59; 95% CI=1·16-2·20); having children (aHR=1·50; 1·08-2.10); non-employment (aHR=1·56; 1·07-2·27 for unemployment; aHR=2·39; 1·70-3·37 for sick/disabled vs employed); rented housing (aHR=1·72; 1·26-2·37 vs homeowner); not enough money for basic needs (aHR=1·82; 1·19-2·78 vs enough); current smoking (aHR=1·39; 1·02-1·91 vs never); recent injection-drug use (aHR=2·11; 1·30-3·43); anxiety symptoms (aHRs=1·39; 1·01-1·91, 2·06; 1·43-2.95 for mild and moderate vs none/minimal); depressive symptoms (aHRs=1·67; 1·17-2·38, 1·91; 1·30-2·78 for moderate and severe vs none/minimal); treated/untreated depression (aHRs=1·53; 1·05-2·24, 1·87; 1·39-2·52). Associations were similar in those with controlled HIV and high CD4. Interpretation: Social and socioeconomic disadvantage, adverse lifestyle factors and poorer mental health are strong predictors of hospitalisation in PLHIV, highlighting the need for targeted interventions and care. Funding Statement: British HIV Association (BHIVA) Research Award (2017); SMR funded by a PhD fellowship from the Royal Free Charity. The ASTRA study presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-0608–10142). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical approval for the ASTRA study was obtained via the North West London research ethics committee (reference 10/H0720/70).