With the discovery of combination antiretroviral treatment in 1996 came a remarkable turning point in the United States epidemic: Not only were people living with HIV living longer, they were staying out of the hospital, with admissions of people whose immune systems had been devastated by the virus dropping steadily, and lengths of stay for those who were hospitalized sharply reduced. Even among an aging population of people 50 and older living with HIV, hospitalizations continued to decline, indicating access to preventive care and management of chronic conditions that can be exacerbated by the virus, a study reported Oct. 22 in Clinical Infectious Diseases notes.
But that progress hasn’t been shared equally, according to the report, Hospitalization Rates and Outcomes among Persons Living with HIV in the Southeastern United States, 1996–2016 and a related commentary, Declining Hospitalizations among Persons With HIV; Time to Leave no One Behind. Together, in data and anecdote, they delineate gaps continuing to lead to late diagnoses and thus treatment access, services to overcome barriers to care, and links to treatment and services for injecting drug use. Hospitalizations with immune cell, or CD 4, counts half the minimal level used as an eligibility marker for treatment more than a decade ago continue with significantly greater frequency among African American and Hispanic populations, and among people who inject drugs. These populations also disproportionately account for hospital readmissions of people living with HIV, indicating that even with diagnosis and treatment initiation, barriers to ongoing outpatient care remain high.
Both article and commentary examine rates of hospitalization and readmission in the Southeastern United States — in North Carolina (where, authors note, Medicaid expansion did not extend the benefits of health coverage offered by the Affordable Care Act and Georgia (which also did not expand Medicaid coverage) the region most impacted by the American HIV epidemic, and home to multiple counties and states targeted by the federal initiative to end HIV as an epidemic.