LAUSR

Hospitalization presents risk for loss of virologic suppression (VS) in people living with HIV (PLWH) due to issues with combination antiretroviral therapy (cART). cART medication errors or drug-drug interactions with new maintenance medications may lead to loss of VS. Appropriate monitoring of HIV RNA post-discharge to ensure ongoing VS may not occur following non-HIV-related illnesses. The objective of this multi-center study was to describe HIV RNA monitoring and VS in PLWH following hospitalization for non-HIV-related illnesses. PLWH at least 18 years old with a CD4 count >200 cells/mm3 on cART prior to admission, hospitalized for 24 hours or more at either of two large, academic medical centers (where they also attended follow-up clinic visits) for a non-HIV-related illness, and that survived to hospital discharge between January 1st 2010 and December 31st 2015 were eligible for analysis. The primary outcome was the presence of an HIV RNA measurement as recommended by national guidelines within 6 months of hospital discharge. Secondary outcomes included the incidence of transient viremia and loss of VS after discharge. A total of 329 patients were included. The median age was 51 years (interquartile range [IQR] 44-58), 76.6% were male, and 48.3% were African American. The median CD4 count was 484 cells/mm3 (IQR 357-629) and 85.4% (n=281) had an undetectable HIV RNA prior to admission. Among the 97.6% (n=321) of patients with an HIV RNA measurement after hospital discharge, the median time to HIV RNA measurement was 2.4 months (IQR=1.2-4.1) and 86.3% (n=284) had an HIV RNA measurement within 6 months. Among patients who were undetectable prior to admission, transient viremia after discharge occurred in 7.1% (n=20) within a median of 2.5 months (IQR 1.3-4.1) and 4 of these patients lost VS. Three of the four patients with loss of VS were admitted for a non-HIV-related infection and all were on protease inhibitor-based regimens. HIV RNA monitoring appears to occur according to guideline recommendations in the majority of PLWH after hospitalization for a non-HIV-related illness. Despite the occurrence of transient viremia, loss of VS was rare. Future studies should focus on risk factors for loss of VS. Milena M. Murray, PharmD, MSc, BCIDP, AAHIVP, Merck (Speaker’s Bureau)