OBJECTIVES : HIV is a chronic infection that results in severe morbidity and mortality if left unmanaged. This study evaluated the economic impact and risk of hospitalization among HIV patients with a hepatitis B (HBV) co-infection.

METHODS : Adult patients with ≥1 diagnosis for HIV during the identification period (01OCT2014-30SEP2017) were included from the VHA population. The first date where both an HIV and HBV diagnosis were present was designated as the index date (case cohort). HIV patients without an HBV diagnosis but with the same age, sex, race, and index year as an HIV/HBV patient were identified as controls. Patients were required to have continuous health plan enrollment for 12 month pre- and post (follow-up) index date. Health care costs and utilization during the follow-up period were compared among case and control patients. Predictors of hospitalization (covariates included age [ref: ≥65 years], race [ref: white], and Charlson comorbidity index [CCI]) score were examined using logistic regression among case (HIV/HBV) patients only.

RESULTS : A total of 1,816 patients were included from both cohorts. Mean age was 57 years and 99% of patients were men. HIV patients with HBV co-infection had higher CCI scores (2.30 vs 2.10; p<0.001) than control patients and were significantly more likely to have concomitant cirrhosis (6.4% vs. 3.9%; p=0.014). During follow up, the HIV/HBV cohort had a higher proportion of patients with ≥1 hospitalization (17.7% vs 5.1%; p<0.001) and incurred significantly higher inpatient ($8,541 vs $1,531), outpatient ($10,036 vs $5,295), pharmacy ($11,792 vs $7,816), and total costs ($30,369 vs $14,642) compared to the control cohort. Among HIV/HBV patients only, higher CCI score (OR: 1.14, 95% CI: 1.06-1.22) was the only significant predictor of hospitalization.

CONCLUSIONS : In the VHA population, HIV patients with HBV co-infection had significantly higher economic burden than those without HBV co-infection.