Targeted interventions could reduce all-cause hospitalization in both groups
A new study published this week in the Journal of the International AIDS Society investigated hospitalization rates and reasons in the U.S. Military HIV Natural History Study (NHS), comparing patients with spontaneous virologic control of HIV to patients with medically controlled HIV.
“HIV controllers (HICs) maintain an undetectable viral load and high CD4 counts without antiretroviral therapy (ART),” said MHRP research physician Dr. Trevor Crowell, the first author on the study. “However, they may also experience immune activation that could predispose them to adverse clinical events such as cardiovascular disease and hospitalization.”
Study participants with consistently well-controlled HIV were identified within the NHS cohort and their hospitalizations were tallied and assigned diagnostic categories. Although prior studies had shown increased rates of all-cause and cardiovascular hospitalizations among spontaneous virologic controllers, these hospitalization rates did not differ between HICs and persons with medically controlled HIV in the NHS. For both groups, non-AIDS defining infections, such as respiratory infections, were common in this young, healthy, predominantly male cohort of military personnel and beneficiaries.
“These findings suggest that targeted interventions should be pursued, such as vaccinations against influenza and pneumococcal pneumonia,” said Dr. Crowell. “Such preventive measures could potentially reduce morbidity and hospitalizations among both HICs and those with medically controlled HIV.”
Dr. Crowell has previously reported increased hospitalization rates among elite controllers of HIV within the multisite HIV Research Network cohort as compared to persons with medically controlled HIV. Pointing out differences in these two studies, Dr. Crowell explained, “Participants in the NHS are an average of about 20 years younger than participants in other large cohorts of persons living with HIV and benefit from the universal access to healthcare available through the military system. The unique characteristics of the NHS are important to consider, especially when evaluating age-related comorbidities such as cardiovascular disease.”
The NHS, which began in 1986, is an ongoing, longitudinal, observational cohort study designed to collect retrospective and prospective data from HIV-infected individuals in U.S. military active duty and DoD health care beneficiary populations. It was the first numbered study (RV1) undertaken by what was then known as the WRAIR Division of Retrovirology, now MHRP. The cohort is now overseen by the Infectious Disease Clinical Research Program (IDCRP) and this analysis was undertaken jointly with their HIV Working Group.