Inpatient initiation of HIV therapy linked patients with substance use disorder to outpatient care

While hospital initiation of antiretroviral therapy was associated with increased frequency of HIV outpatient care visits in one trial of participants with HIV and substance use disorder, only 15% started antiretroviral therapy in the hospital, and viral suppression was not improved.


Antiretroviral therapy initiation in the hospital was associated with linkage to outpatient HIV care in patients with HIV and substance use disorder, but it was not associated with retention in HIV care or viral suppression, a recent analysis of a randomized trial found.

Researchers used data from a randomized clinical trial to look at patients with HIV and substance use disorder from 11 U.S. hospitals. Their secondary analysis focused on factors related to initiating and reinitiating antiretroviral therapy in the hospital and its association with linkage to HIV care, frequency of outpatient care visits, retention in care, and viral suppression. Participants were followed for 12 months. Viral load, CD4 cell count, and HIV care visits were determined by laboratory tests and medical records abstraction, and patient characteristics and behaviors were determined through self-report. Results were published online on June 22 by Clinical Infectious Diseases.

Of 801 participants, 124 (15%) initiated antiretroviral therapy in the hospital, 80 (65%) of whom were starting antiretroviral therapy for the first time. Hospital initiation of antiretroviral therapy was associated with increased frequency of HIV outpatient care visits at six-month (adjusted odds ratio, 1.39; 95% CI, 1.02 to 1.88) and 12-month follow-up assessments (adjusted odds ratio, 1.53; 95% CI, 1.15 to 2.04). However, it was not significantly associated with retention in HIV care or viral suppression over a 12-month period. The median number of days from discharge to HIV primary care visit was 29 days among those who initiated antiretroviral therapy in the hospital, compared with 54 days among those who did not (P=0.0145). Participants with hospital-initiated antiretroviral therapy had longer stays compared to participants without (P<0.001). Those recruited in Southern hospitals were less likely than those in non-Southern hospitals to initiate antiretroviral therapy in the hospital (P<0.001), whereas past-year opioid use (P=0.001) and history of substance use disorder treatment (P=0.008) were associated with greater likelihood of hospital antiretroviral therapy initiation.

Limitations of the study include its inability to prove causation and to adjust for unmeasured confounders, the authors noted. They added that despite the study's multisite design and large sample size, results may not generalize to the broader U.S. population or to international settings.

The lack of association with antiretroviral therapy and retention in care and viral suppression over 12 months may be due to a lack of structural and system factors to support these outcomes, the authors noted. Although starting antiretroviral therapy in the hospital may be beneficial in patients living with HIV and substance use disorder, “Our study shows this approach is not widely implemented in hospital settings,” they concluded.