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BACKGROUND: The healthcare burden of the intersecting epidemics of human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV) has not been extensively studied. Most studies have focused on viral co-infection in clinical settings, leading to gaps in knowledge on the impact of co-infection at a population level. Through examination of the healthcare and financial burdens of HIV, HCV, and HBV in a large hospital billing database, hospitalization trends and high risk subgroups can be characterized.
METHODS: Hospitalization data for residents of southeastern Pennsylvania were extracted from Pennsylvania Health Care Cost Containment Council (PHC4) hospital billing database for 1996-2010. Infection status was determined by ICD-9 codes indicative of infection or co-infection. The mean hospitalizations for patients in co-infection groups were compared to those for mono-infection groups.
RESULTS: 9750 persons infected with HCV were identified, with a mean of 13.69 hospitalizations per patient. 1426 HBV cases and 4796 HIV cases were also found, with mean hospitalizations of 17.99 and 11.18 visits per patient, respectively. Among the co-infection groups, 660 cases of HIV/HCV, 609 cases of HBV/HCV, and 194 cases of HIV/HBV were identified, with average hospitalizations of 17.47, 20.33, and 19.05 visits per patient, respectively. Generally, hospitalizations were higher for those identified with co-infections versus mono-infected individuals. On average, those with HIV/HCV co-infections had 6.3 more visits than individuals with HIV mono-infections and 3.8 more visits than HCV mono-infected individuals (p<0.0001). Individuals with HBV/HCV co-infection exhibited an average of 2.3 more visits than those with HBV mono-infection (p<0.02) and 6.6 more visits than those with HCV mono-infection (p<0.0001). As compared to HIV mono-infected persons, individuals co-infected with HIV/HBV had an average of 1.1 more hospital visits per patient (p<0.0001). No significant difference was seen for HBV mono-infection and HIV/HBV co-infection.
CONCLUSIONS: The observed increases in the number of hospitalizations for virally co-infected persons relative to mono-infected persons indicates a critical need for early identification and treatment of co-infected persons, as well as services integration at both the screening and treatment levels. Further knowledge of the health care burden and financial impact of the intersecting epidemics of HIV, HCV, and HBV infection is vital to future program planning and development.