The study authors suggest further research and investment to identify areas of support for individuals at the highest risk of poor outcomes.
After hospital discharge, people living with HIV experience high rates of mortality and readmission, according to a systematic review published in The Lancet HIV.
Investigators from Switzerland and South Africa used PubMed and Embase database research from 2003 to 2021 to identify relevant studies that reported outcomes among people with HIV following hospital discharge in order to estimate the frequency of negative post-discharge outcomes and determine the risk factors for those outcomes.
Other studies have suggested low CD4 cell count, lack of antiretroviral therapy (ART), and discharge against medical advice as factors associated with poor outcomes following hospital discharge, the study authors noted. The research was funded by the Bill & Melinda Gates Foundation, the study authors noted.
Ultimately, the study authors included 29 cohorts in their analysis which reported the outcomes for more than 90,000 people living with HIV after hospital discharge. These studies primarily took place in North America, the study authors said, though there were several from Africa and South Africa. All but 1 of the studies was focused on adult patients. The study authors also said that 11 of the studies reported length of hospital stay, which ranged from 4 to 12 days.
Of those patients included in the meta-analysis, 18 percent were readmitted to the hospital after discharge and 14 percent died following hospital discharge, the study authors wrote. The study authors observed that no difference was found in the proportion of patients who died following discharge when comparing studies before and after 2016, they said. They also found that post-discharge mortality was higher in studies from Africa than those that took place in the US, and from studies in low- and middle-income countries compared to high-income countries. Post-discharged mortality rates also increased when looking at studies where the follow-up was greater than 30 days, the study authors added.
In this meta-analysis, the study authors found that lower CD4 cell count and a lack of linkage to care within 1 month post-discharge were associated with post-discharge mortality. They said this may have been the result of advanced HIV disease status among people who were admitted to the hospital, though. They noted that early linkage to primary HIV care was associated with a 75 percent lower incidence of post-discharge mortality.
Some risk factors for readmission that the study authors found in their meta-analysis included low CD4 cell count at admission, longer length of stay, not being on ART, discharge against medical advice, and not linking to care after discharge, they wrote. They also added that a US study highlighted the importance of tailored support for febrile patients who inject drugs, as they had a higher rate of rehospitalization rate among those with newly-diagnosed HIV infection compared to those with known HIV infection.
“This systematic review found high rates of mortality and readmission after hospital discharge of people living with HIV, highlighting the importance of ensuring post-discharge referral and appropriate post-discharge management to improve outcomes among these vulnerable patients,” the study authors concluded. “Further research and investment is needed to identify feasible approaches targeting individuals at highest risk of poor outcomes after discharge and to provide adapted support to ensure appropriate linkage and continuity of support post-discharge, including ART.”