The impact of HIV/HCV co‐infection on health care utilization and disability: results of the ACTG Longitudinal Linked Randomized Trials (ALLRT) Cohort

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Abstract
Summary. HIV/hepatitis C virus (HCV) co‐infection places a growing burden on the HIV/AIDS care delivery system. Evidence‐based estimates of health services utilization among HIV/HCV co‐infected patients can inform efficient planning. We analyzed data from the ACTG Longitudinal Linked Randomized Trials (ALLRT) cohort to estimate resource utilization and disability among HIV/HCV co‐infected patients and compare them to rates seen in HIV mono‐infected patients. The analysis included HIV‐infected subjects enrolled in the ALLRT cohort between 2000 and 2007 who had at least one CD4 count measured and completed at least one resource utilization data collection form (N = 3143). Primary outcomes included the relative risk of hospital nights, emergency department (ED) visits, and disability days for HIV/HCV co‐infected vs HIV mono‐infected subjects. When controlling for age, sex, race, history of AIDS‐defining events, current CD4 count and current HIV RNA, the relative risk of hospitalization, ED visits, and disability days for subjects with HIV/HCV co‐infection compared to those with HIV mono‐infection were 1.8 (95% CI: 1.3–2.5), 1.7 (95% CI: 1.4–2.1), and 1.6 (95% CI: 1.3–1.9) respectively. Programs serving HIV/HCV co‐infected patients can expect approximately 70% higher rates of utilization than expected from a similar cohort of HIV mono‐infected patients.