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Original article
Trends in hospital admissions, re-admissions, and in-hospital mortality among HIV-infected patients between 1993 and 2013: Impact of hepatitis C co-infection
Tendencia de las hospitalizaciones, reingresos y mortalidad intrahospitalaria en los pacientes infectados por VIH entre 1993-2013: impacto de la coinfección por el virus de la hepatitis C
Héctor Meijidea,b,, Álvaro Menaa,,
Corresponding author
alvaro.mena.de.cea@sergas.es

Corresponding author.
, Iria Rodríguez-Osorioa, Sonia Pértegac, Ángeles Castro-Iglesiasa, Guillermo Rodríguez-Martínezd, José Pedreiraa, Eva Povedaa
a Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
b Servicio de Medicina Interna, Hospital Quiron, A Coruña, Spain
c Unidad de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
d Unidad de Admisión y Documentación Clínica, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, A Coruña, Spain
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            "entidad" => "Unidad de Epidemiolog&#237;a Cl&#237;nica y Bioestad&#237;stica&#44; Instituto de Investigaci&#243;n Biom&#233;dica de A Coru&#241;a &#40;INIBIC&#41;-Complexo Hospitalario Universitario de A Coru&#241;a &#40;CHUAC&#41;&#44; Sergas&#44; Universidade da Coru&#241;a &#40;UDC&#41;&#44; Spain"
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            "entidad" => "Unidad de Admisi&#243;n y Documentaci&#243;n Cl&#237;nica&#44; Complexo Hospitalario Universitario de A Coru&#241;a &#40;CHUAC&#41;&#44; Sergas&#44; A Coru&#241;a&#44; Spain"
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        "titulo" => "Tendencia de las hospitalizaciones&#44; reingresos y mortalidad intrahospitalaria en los pacientes infectados por VIH entre 1993-2013&#58; impacto de la coinfecci&#243;n por el virus de la hepatitis C"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Hospitalization rate in HIV&#47;HCV coinfected and HIV monoinfected patients&#46; Joinpoint regression analysis&#58; trends in hospitalizations in HIV&#47;HCV coinfected and HIV monoinfected patients&#46; Estimated Annual percent change &#40;bold if statistically significant&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001 in all cases&#41;&#46; In comparison between HIV&#47;HCV coinfected and HIV monoinfected patients&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;65 in the first period &#40;1993&#8211;1996&#41; and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001 in the second &#40;1996&#8211;2013&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Since the introduction of Highly Active Antiretroviral Therapy &#40;HAART&#41; in 1996&#44; the profile of people living with HIV infection &#40;PLWH&#41; has changed significantly&#59; with an appreciable decline of mortality related to AIDS-defining diseases and an improvement in life expectancy&#46; However&#44; the incidence of other comorbidities&#44; mainly cardiovascular diseases and non-AIDS tumors has increased&#44; due to the longer life expectancy&#44; aging and persistent inflammation related to the HIV-infection&#44; even in a context of long-term suppression of viremia&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#8211;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">From a public health perspective&#44; it is important to understand trends and characteristics of hospitalizations&#44; re-admissions and mortality rates among PLWH&#46; However&#44; there are few available data among too heterogeneous study populations in different socioeconomic contexts and Health Care systems&#46; In the general population&#44; 30-days readmission rates are increasingly becoming a benchmark for hospital quality of care and costs&#44; also for PLWH&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The causes of hospitalizations have been changing in the HAART era&#46; AIDS defining illnesses are less represented nowadays&#44; but patients are older with more comorbidities&#46; Therefore&#44; the reasons for hospitalizations incidence&#44; mortality and readmission rates might be changing&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">6&#8211;10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Chronic hepatitis C virus &#40;HCV&#41; coinfection is common in PLWH &#40;30&#8211;50&#37; according to different series&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> It is estimated that at least 30&#37; of patients with HCV develop cirrhosis and around 1&#8211;4&#37; of these will develop hepatocellular carcinoma&#46; The risk of progression of liver disease is 2&#8211;6 times higher in HIV&#47;HCV coinfected than in HCV mono-infected patients&#44; which involves a high-related morbidity and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">12&#8211;16</span></a> However&#44; the risk of hepatic decompensation and progression of liver fibrosis is drastically reduced with treatment and cure of HCV infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this context&#44; the aim of this study was to analyze trends in hospitalization&#44; re-admission and mortality rates in PLWH followed in a reference hospital in Northwest Spain in the last 20 years&#46; Moreover&#44; the impact of HCV coinfection in the dynamic of all these parameters was also evaluated&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">The Complexo Hospitalario Universitario de A Coru&#241;a &#40;CHUAC&#41; is a 1422-bed&#44; full service&#44; 24<span class="elsevierStyleHsp" style=""></span>h ICU availability&#44; tertiary acute university care hospital&#44; serving in the Northwest of Spain&#46; The influence population in 2013 was 547&#44;776 citizens&#44; and that year reported 40&#44;869 admissions &#40;21&#37; scheduled&#41;&#46; The HIV and Hepatitis Viral Unit offers outpatient and inpatient medical care to all PLWH in this reference area&#44; attending more than 1400 PLWH by HIV-trained doctors&#46; PLWH are not attended in other hospitals in this area&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Data collection</span><p id="par0035" class="elsevierStylePara elsevierViewall">All hospital admissions of HIV-infected patients at CHUAC between 1993 and 2013 were obtained through the Hospital-coding Department&#46; Hospitalization reasons were collected following the International Classification of Diseases&#44; Ninth Revision &#40;ICD-9&#41;&#46; Several steps were taken in assigning each hospitalization to a single diagnostic category&#46; To determine the reliably ICD-9 code the first listed referring to neither HIV &#40;042&#44; V08&#44; 795&#46;71&#44; V01&#46;79&#41; nor chronic hepatitis C &#40;070&#46;44&#44; 070&#46;54&#44; 070&#46;70&#44; 070&#46;71&#41; nor oral candidiasis &#40;120&#46;0&#41; was defined as the primary code for hospitalization&#46; These codes represent comorbidities that are not&#44; by themselves&#44; sufficient to justify hospitalization&#46; Recurrent bacterial pneumonia was defined as a bacterial pneumonia admission occurring within &#62;30 but &#60;365 days of a previous such admission&#46; Hospitalizations whose first ICD-9 code was chemotherapeutic treatment were assigned to the first code based on the type of cancer&#46; Clinical Classification Software &#40;CCS&#41;&#44; developed by the Agency for Healthcare Research and Quality<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a> was used to assign primary ICD-9 code into one of 18 first-level categories&#46; Finally&#44; using a method similar to one it has previously employed&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> CCS classification was modified and categories were pooled together at major syndromes for further analysis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Epidemiological and clinical data related to hospitalizations and mortality were recorded&#46; HIV&#47;HCV coinfection was considered if RNA-HCV viral load was detectable&#46; Mean length of hospital stay was evaluated by subtracting the date of discharge &#8211; the date of admission and adding 1&#46; For patients that were discharged the day of admission&#44; it was considered 1&#46; Re-admission was defined as hospitalization occurred before 30 days after discharge&#46; Years of active outpatient care were defined by having at least one HIV clinician visit and one measured CD4 cell count&#46; Scheduled admissions were considered if the patient were not in the Emergency Department prior to hospitalization&#46; Death due to an AIDS-defining illness was defined as death attributable to one of the Centers for Disease Control Prevention &#40;CDC&#41; category C diseases&#46; Death due to non AIDS-defining illness was classified according to CoDe protocol &#40;&#8220;Coding of Death in HIV&#8221;&#44; in <a href="http://www.cphiv.dk/CoDe">www&#46;cphiv&#46;dk&#47;CoDe</a>&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study is in accordance with the community standards and approved by the ethics committee&#46; The study&#39;s protocol was reviewed and approved by the Medical Ethics Committee of the University Hospital of Galicia&#46; All clinical data were anonymous and de-identified prior to analyze&#44; the identification numbers of the patients were recorded blindly&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analyses</span><p id="par0050" class="elsevierStylePara elsevierViewall">Hospitalization rate was evaluated as number of hospitalizations per 100 patients&#46; For the denominator&#44; the number of patients in care each year in the HIV clinic&#44; was used&#59; it was collected from medical records and electronic database of patients in follow up&#46; The study was divided in two periods of time &#40;1993&#8211;2002 and 2003&#8211;2013&#41; to be compared with a comparative cross-sectional analysis&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Quantitative data were reported using means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviations &#40;SD&#41; or median &#40;range&#41;&#44; as indicated&#46; For qualitative variables&#44; absolute numbers and percentages were computed&#46; The comparison of quantitative parameters was carried out using Student&#39;s <span class="elsevierStyleItalic">t</span> test&#46; The association of qualitative variables was carried out using Chi-squared statistic&#59; the relative risk &#40;RR&#41; was calculated&#46; A two-sided type I error of 5&#37; was considered statistically significant&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A time-trend joinpoint regression analysis was performed&#46; This technique provides the estimated annual percent change &#40;APC&#41; and allows detecting points in time at which significant changes in the trends occur&#46; For each APC estimate&#44; 95&#37; confidence interval was also calculated&#46; Statistical analysis was performed using SPSS for Windows &#40;version 19&#46;0&#44; SPSS Inc&#46;&#44; Chicago&#44; IL&#41;&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Demographic characteristics and hospitalization parameters</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 2498 PLWH were followed during the period study&#44; contributing to 22&#44;901 patient-years &#40;PY&#41;&#46; In the study period 6917 hospital admissions were recorded&#44; corresponding to 1937 subjects&#46; Of them&#44; 75&#46;0&#37; were male&#44; mean age &#40;at first hospitalization&#41; was 36&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;6 years&#44; and 37&#46;2&#37; were HIV&#47;HCV coinfected&#46; Among those PLWH hospitalized&#44; 789 &#40;40&#46;7&#37;&#41; have one admission&#59; the median number of admission was 2 &#40;IQR&#58; 1&#8211;4&#41;&#46; The hospitalization rate showed a reduction from 30&#46;7&#47;100 patients &#40;CI95&#37;&#58; 27&#46;7&#8211;33&#46;8&#41; in 1993 to 19&#46;9&#47;100 patients &#40;17&#46;7&#8211;22&#46;2&#41; in 2013 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#59; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the hospitalization and mortality each year and the number of patients on follow-up&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In the comparative analysis between both periods &#40;1993&#8211;2002 vs&#46; 2003&#8211;2013&#41;&#44; differences in hospitalization reasons were recognized among periods &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The main 5 reasons for hospitalization were&#58; pneumonia &#40;10&#46;5&#37;&#41;&#44; chronic pulmonary disease&#47;respiratory failure &#40;8&#46;3&#37;&#41;&#44; tuberculosis &#40;7&#46;4&#37;&#41;&#44; hepatic decompensation &#40;6&#46;3&#37;&#41; and psychiatric disorder&#47;drug-abuse &#40;5&#46;3&#37;&#41;&#46; Overall&#44; 23&#46;1&#37; of the total of 6917 hospitalizations was AIDS-defining illnesses&#44; with differences between first &#40;28&#46;0&#37;&#41; and second period &#40;16&#46;2&#37;&#41;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Re-admissions and mortality rates by clinical units</span><p id="par0075" class="elsevierStylePara elsevierViewall">Overall&#44; 5759 &#40;83&#46;3&#37;&#41; were considered primary hospitalizations&#44; 998 &#40;14&#46;4&#37;&#41; were first re-admissions and 160 &#40;2&#46;3&#37;&#41; were subsequent re-admissions in a chain&#46; The median length of hospital stay was 8&#46;0 days &#40;5&#46;0&#8211;16&#46;0&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The re-admission rate was 20&#46;1&#37; &#40;CI95&#37;&#58; 19&#46;1&#8211;21&#46;2&#41; without differences by gender &#40;20&#46;3&#37; in men vs&#46; 19&#46;7&#37; in women&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;21&#41;&#46; Mean age of patients in hospitalizations without a re-admission &#40;37&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;4&#41; was similar than those re-admitted &#40;37&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;9 years&#41;&#46; A higher rate of re-admissions was observed for some services such as Onco-Hematology &#40;68&#46;5&#37;&#41;&#44; Gynecology&#8211;Obstetrics &#40;24&#46;2&#37;&#41;&#44; Internal Medicine-Infectious Diseases &#40;20&#46;0&#37;&#41; or Pediatric Unit &#40;16&#46;3&#37;&#41;&#46; Those with lower rate were&#58; surgery units &#40;13&#46;2&#37;&#41; or Psychiatry Unit &#40;8&#46;2&#37;&#41;&#46; Main reasons for hospital admission have different re-admission rates&#58; tumoral diseases 33&#46;8&#37;&#44; hepatic decompensations 23&#46;5&#37;&#44; chronic pulmonary diseases 20&#46;8&#37;&#44; infectious diseases 18&#46;9&#37;&#44; cardiovascular diseases 14&#46;9&#37;&#44; and psychiatric disorders 12&#46;8&#37;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Between 1993&#8211;2013&#44; 453 in-hospital deaths were identified&#44; with an overall inpatient mortality rate of 6&#46;5&#37; &#40;CI95&#37;&#58; 6&#46;0&#8211;7&#46;1&#41;&#46; Globally&#44; the mortality of hospitalizations for males was higher than for women &#40;7&#46;4&#37; vs&#46; 4&#46;4&#37;&#44; RR&#58; 1&#46;7 &#91;1&#46;3&#8211;2&#46;1&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Mean age of patients who died during the hospitalizations was 40&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;3 years&#44; significantly higher &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; than that of those who did not die &#40;37&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;4 years&#41;&#46; Mortality of primary hospitalizations was 5&#46;7&#37; vs&#46; 11&#46;0&#37; among re-admissions &#40;RR 1&#46;93 &#91;1&#46;59&#8211;2&#46;35&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; AIDS-defining illnesses hospitalizations presented a mortality of 13&#46;4&#37;&#44; while in non AIDS-defining diseases was 4&#46;5&#37; &#40;RR&#58; 3&#46;0 &#91;2&#46;5&#8211;3&#46;6&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">There were differences in mortality rate by Units &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;005&#41;&#58; Onco-Hematology &#40;12&#46;4&#37;&#41;&#44; Internal Medicine-Infectious Diseases &#40;6&#46;7&#37;&#41;&#44; Surgery &#40;3&#46;6&#37;&#41; and Pediatric &#40;3&#46;5&#37;&#41;&#46; No patient&#39;s death in Gynecology&#8211;Obstetrics or Psychiatry Unit&#46; There were 24 hospitalizations admitted in ICU directly from the Emergency Department&#44; 21 of them &#40;87&#46;5&#37;&#41;&#44; died during the ICU stay&#46; Hospitalizations that were admitted in ICU &#40;whenever during the hospitalization&#41; had higher mortality rate &#40;35&#46;5&#37;&#41; than those without ICU care &#40;5&#46;3&#37;&#41; &#40;RR 6&#46;6 &#91;5&#46;5&#8211;8&#46;0&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; The main causes of in-patient death and the change between both periods are detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">HIV&#47;HCV coinfection</span><p id="par0095" class="elsevierStylePara elsevierViewall">A total of 716 HIV&#47;HCV coinfected patients were hospitalized at least once during the study period&#44; giving a total of 3525 hospitalizations &#40;1408 between 1993&#8211;2002 and 2117 between 2003&#8211;2013&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> depicts the changes in incidence during the follow up&#46; In the joinpoint regression analysis&#44; two different trends were observed&#46; Hospitalizations rate increased between 1993 and 1996 in all cohort &#40;APC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#46;8&#37;&#41;&#46; Between 1997 and 2013&#44; hospitalizations rate decreased much more in HIV mono-infected &#40;APC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;4&#46;9&#37;&#41; than in HIV&#47;HCV coinfected &#40;APC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#46;7&#37;&#41;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Overall&#44; the mean length of stay in HCV coinfected patients was similar than in mono-infected &#40;median&#58; 10&#46;1 days &#91;6&#46;3&#8211;15&#46;9&#93; vs&#46; 11&#46;0 &#91;6&#46;0&#8211;19&#46;5&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;24&#41;&#59; but coinfected had more hospitalizations per patient &#40;median&#58; 3&#46;0 &#91;1&#46;0&#8211;6&#46;0&#93; vs&#46; 2&#46;0 &#91;1&#46;0&#8211;3&#46;0&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and higher readmission rates &#40;21&#46;5&#37; vs&#46; 19&#46;1&#37;&#44; RR&#58; 1&#46;1 &#91;1&#46;0&#8211;1&#46;2&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; The sum of total days of hospitalization per patient during the follow-up was higher among HIV&#47;HCV coinfected than in HIV mono-infected &#40;median&#58; 36&#46;0 days &#91;14&#46;0&#8211;77&#46;5&#93; vs&#46; 23&#46;0 days &#91;9&#46;0&#8211;51&#46;0&#93;&#44; respectively&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The main causes of hospitalization in coinfected patients&#44; comparatively with HIV-monoinfected&#44; are illustrated in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46; A decrease of infectious diseases and psychiatric disorders was evidenced&#46; On the other hand&#44; an important increase in hospitalizations due to hepatic decompensations was found &#40;from 5&#46;8&#37; to 11&#46;5&#37;&#44; RR&#58; 2&#46;0 &#91;CI95&#37;&#58; 1&#46;5&#8211;2&#46;6&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Mortality rate of hospitalizations in HIV&#47;HCV coinfected increases from 4&#46;0&#37; &#40;1993&#8211;2002&#41; to 6&#46;2&#37; &#40;2003&#8211;2013&#41;&#44; RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;5 &#40;1&#46;1&#8211;2&#46;1&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; There were also differences in mortality reasons&#58; infectious diseases mortality decreased significantly &#40;RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;6 &#91;&#46;4&#8211;&#46;9&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; tumors increased &#40;RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;1 &#91;&#46;5&#8211;8&#46;8&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41; and hepatic decompensations also increased from 15&#46;6&#37; to 21&#46;2&#37; &#40;RR&#58; 1&#46;4 &#91;&#46;6&#8211;3&#46;3&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">This study evaluates trends in hospitalizations among PLWH in a medical reference area of Northwest Spain&#46; Overall&#44; the hospitalizations rate showed a decline from 31&#47;100 patients in 1993 to 20&#47;100 patients in 2013&#44; but remains higher than in the general population&#46; These results are concordant with other previously published in different countries and different Health Care Systems&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">6&#44;21</span></a> The joinpoint analysis established a point of change in 1996&#46; This behavior is related with the introduction of HAART and its rapid impact in AIDS-defining illnesses&#46; In this year&#44; the trend of hospitalization incidence changed from a yearly growing of 11&#46;8&#37; toward a yearly decreasing of 3&#46;4&#37;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Changes in the reasons of hospital admission were also observed between the two periods evaluated&#46; Thus&#44; a significant decrease in hospitalizations due to infectious &#40;mainly AIDS-defining diseases&#41; and psychiatric disease or drugs abuse was recognized in contrast to a progressive increase of malignancies specially those non AIDS-defining&#44; chronic respiratory&#44; cardiovascular and liver related diseases&#46; Overall&#44; hospitalizations due to AIDS-defining diseases dropped &#40;from 28&#46;0&#37; to 16&#46;2&#37;&#41; in our cohort&#44; but their mortality did not change significantly &#40;15&#46;0&#37; in 1993&#8211;2003 and 12&#46;3&#37; in 2004&#8211;2013&#41;&#46; AIDS-defining diseases and their high mortality remain a current problem worldwide&#59; this problem must be addressed from the universalization of HAART and improving the diagnostic strategies&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Accordingly&#44; changes in hospitalization units were also observed&#46; Thus&#44; in the second period there was an increase in hospitalizations in surgical areas and onco-haematologic units&#44; likely due to an increase in the life expectancy among HIV-infected patients in the second period because the access to specific treatments as for the general population&#46; The rates of ICU admissions increased up to 3-times&#44; probably caused by the same reasons&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">However&#44; the average length of stay and re-admission rates remain high&#44; similar to those reflected in other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">10&#44;20</span></a> probably due to an increase in the comorbidities associated with HIV infection&#44; that involve greater complexity of clinical management in this group of patients&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Despite the improvement in the care of PLWH&#44; the in-hospital mortality remains high&#59; in this cohort the mortality in men is 1&#46;7 times higher than in women&#44; according to data published previously&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">21&#44;22</span></a> Non-AIDS deaths increased significantly during the ART era and nowadays are the main cause of in-hospital mortality in PLWH&#46; Non-AIDS infections&#44; cirrhosis and its complications&#44; and malignancies were major contributors to mortality&#46; Non-AIDS mortality increased by 80&#46;5&#37; between first and second period&#59; consequently&#44; AIDS mortality decreased by 49&#46;0&#37;&#46; Cowell et al&#46;&#44; reported similar trends recently&#44; in a huge American cohort&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The 30 days re-admission rate in our cohort was 20&#46;1&#37;&#44; similar to data recently reported by Berry et al&#46; &#40;19&#46;3&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a> The re-admission rate has an important impact on long-term health and mortality rate of PLWH&#46; Indeed&#44; some mathematical models are developed to predict re-admission&#44; but they need to be validated in other populations&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Within this cohort&#44; nearly 40&#37; were HIV&#47;HCV coinfected patients&#46; They had more hospitalizations&#44; re-admissions and the sum of the total stays were significantly greater than for HIV mono-infected&#44; similarly to that previously published&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> Interestingly&#44; the incidence of hospitalizations in 2013 was double in coinfected compared to HIV mono-infected&#46; Indeed&#44; although the hospitalization rate decreases since 1996&#44; the APC is near to three times higher in mono-infected than in coinfected&#46; Therefore&#44; in terms of hospitalizations and in-hospital mortality&#44; HCV coinfection seems to mask the beneficial effect of HAART and improvements in HIV care&#44; although other factors such IDU or alcohol could also play a significant role&#46; Hospitalizations due to hepatic decompensation are double in the last ten years &#40;2003&#8211;2013&#41; compared with the first period &#40;1993&#8211;2002&#41;&#46; Moreover&#44; Meyers et al&#46; described recently that HCV mortality appears to be relatively stable while total HIV&#47;AIDS deaths are on a decline across the state of Massachusetts in a trend analysis of HIV and HCV using multiple cause of death&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">25</span></a> All these data suggest that hospitalizations&#44; decompensations and mortality will increase in the next years if HCV infection is not eradicated&#46; The impact of a wide access to new anti-HCV therapies in HIV-infected patients must be evaluated in the near future&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">26-28</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">There are some limitations in our study that merit discussion&#46; This is a retrospective observational study&#44; using data recorded from a single hospital that it could affect the generalizability of our finding&#46; However&#44; this is a reference hospital with more than 1000-beds and a large cohort of HIV- and HCV-infected patients in follow-up in this institution since the beginning of both epidemics&#46; Although there are not other HIV outpatient clinics in our area&#44; some patients had an admission without any follow up in our clinic&#59; it could overestimate hospitalization rates&#46; Moreover&#44; there are some variables that might be also associated with mortality that were not collected &#40;i&#46;e&#46; smoking&#44; or years under HAART exposure&#41; and therefore its specific impact in hospitalizations and rates of mortality could not be analyzed&#46; Data of CD4 count&#44; HAART and viral suppression were not available&#44; the effect of this important factors in PLWH was not analyzed&#46; Patients admitted in Onco-Hematology Units to receive scheduled chemotherapy &#40;12&#37;&#41; could overestimate the hospitalization rate in these Units and underestimate the in-hospital mortality in them&#46; The study did not include HCV-infected patients treated with new DAAs based therapies&#44; neither a control group of hospitalized HIV-negative patients&#46; Finally&#44; it is possible that the use of the ICD-9 coding system might introduce coding errors&#44; although minority&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In summary&#44; in this large cohort of PLWH&#44; followed during 20 years&#44; a decrease in the hospitalizations rate and a progressive decline of AIDS defining illnesses have been recognized&#46; Consequently&#44; chronic comorbidities and malignancies have been increasing within the last ten years&#46; However&#44; the length of stay&#44; re-admission and the mortality rate remains high&#46; HCV coinfection has a negative impact in these parameters and is associated with increases in the morbidity and mortality and therefore in the resource consumption among PLWH&#46; These findings are essential to improve and optimize the clinical management of PLWH and to pay special attention in those comorbidities that favor the hospitalization and mortality rates nowadays&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">All authors declare no conflicts of interest&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">New patterns in epidemiological characteristics of people living with HIV infection &#40;PLWH&#41; and the introduction of Highly Active Antiretroviral Therapy &#40;HAART&#41; have changed the profile of hospital admissions in this population&#46; The aim of this study was to evaluate trends in hospital admissions&#44; re-admissions&#44; and mortality rates in HIV patients and to analyze the role of HCV co-infection&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study conducted on all hospital admissions of HIV patients between 1993 and 2013&#46; The study time was divided in two periods &#40;1993&#8211;2002 and 2003&#8211;2013&#41; to be compared by conducting a comparative cross-sectional analysis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 22&#44;901 patient-years were included in the analysis&#44; with 6917 hospital admissions&#44; corresponding to 1937 subjects &#40;75&#37; male&#44; mean age 36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11 years&#44; 37&#37; HIV&#47;HCV co-infected patients&#41;&#46; The median length of hospital stay was 8 days &#40;5&#8211;16&#41;&#44; and the 30-day hospital re-admission rate was 20&#46;1&#37;&#46; A significant decrease in hospital admissions related with infectious and psychiatric diseases was observed in the last period &#40;2003&#8211;2013&#41;&#44; but there was an increase in those related with malignancies&#44; cardiovascular&#44; gastrointestinal&#44; and chronic respiratory diseases&#46; In-hospital mortality remained high &#40;6&#46;8&#37; in the first period vs&#46; 6&#46;3&#37; in the second one&#41;&#44; with a progressive increase of non-AIDS-defining illness deaths &#40;37&#46;9&#37; vs&#46; 68&#46;3&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; The admission rate significantly dropped after 1996 &#40;4&#46;9&#37; yearly&#41;&#44; but it was less pronounced in HCV co-infected patients &#40;1&#46;7&#37; yearly&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hospital admissions due to infectious and psychiatric disorders have decreased&#44; with a significant increase in non-AIDS-defining malignancies&#44; cardiovascular&#44; and chronic respiratory diseases&#46; In-hospital mortality is currently still high&#44; but mainly because of non-AIDS-defining illnesses&#46; HCV co-infection increased the hospital stay and re-admissions during the study period&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los cambios en las caracter&#237;sticas epidemiol&#243;gicas de los pacientes con infecci&#243;n por el VIH&#44; y la introducci&#243;n del tratamiento antirretroviral de alta eficacia&#44; han modificado el perfil de las hospitalizaciones en esta poblaci&#243;n&#46; El objetivo del estudio fue evaluar las tendencias en hospitalizaci&#243;n&#44; reingreso y mortalidad en pacientes VIH&#44; y analizar el papel de la coinfecci&#243;n por el VHC&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes retrospectivo&#44; que incluy&#243; todas las hospitalizaciones de pacientes VIH entre 1993-2013&#46; El estudio fue dividido en 2 periodos &#40;1993-2002 y 2003-2013&#41; para ser comparados mediante un an&#225;lisis transversal&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 22&#46;901 pacientes&#47;a&#241;os&#44; que presentaron 6&#46;917 hospitalizaciones que correspondieron a 1&#46;937 pacientes &#40;75&#37; varones&#44; edad media 36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11 a&#241;os&#44; 37&#37; coinfectados VIH&#47;VHC&#41;&#46; La mediana de estancia hospitalaria fue de 8 d&#237;as &#40;5-16&#41;&#44; y la tasa de reingreso a los 30 d&#237;as del 20&#44;1&#37;&#46; Se observ&#243; un descenso significativo en el segundo periodo &#40;2003-2013&#41; de las hospitalizaciones motivadas por enfermedades infecciosas y trastornos psiqui&#225;tricos&#44; y un incremento de aquellas relacionadas con neoplasias&#44; enfermedad cardiovascular&#44; gastrointestinal y enfermedades respiratorias cr&#243;nicas&#46; La mortalidad intrahospitalaria permanece elevada &#40;6&#44;8&#37; en el primer periodo vs&#46; 6&#44;3&#37; en el segundo&#41;&#44; con un aumento progresivo de las muertes por enfermedades no definitorias de sida &#40;37&#44;9 vs&#46; 68&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La tasa de hospitalizaci&#243;n disminuy&#243; de manera significativa despu&#233;s de 1996 &#40;4&#44;9&#37; anual&#41;&#44; pero este descenso fue menos acusado en los pacientes coinfectados VIH&#47;VHC &#40;1&#44;7&#37; anual&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las hospitalizaciones motivadas por enfermedades infecciosas y trastornos psiqui&#225;tricos han descendido&#59; por el contrario&#44; se observ&#243; un aumento significativo de aquellas relacionadas con neoplasias no definitorias de sida&#44; enfermedad cardiovascular y enfermedades respiratorias cr&#243;nicas&#46; La mortalidad intrahospitalaria permanece a d&#237;a de hoy elevada&#44; pero a expensas fundamentalmente de enfermedades no definitorias de sida&#46; La coinfecci&#243;n VIH&#47;VHC increment&#243; los d&#237;as de hospitalizaci&#243;n y los reingresos durante el periodo de estudio&#46;</p></span>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1993&#8211;2002 &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3463&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2003&#8211;2013 &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3454&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative change &#40;&#37;&#41; &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Scheduled admissions &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;36&#46;3 &#40;&#8722;40&#46;5&#59; &#8722;31&#46;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Length of stay &#40;median&#44; IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;0 &#40;5&#46;0&#8211;16&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;0 &#40;4&#46;0&#8211;15&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;9&#46;9 &#40;&#8722;18&#46;7&#59; 2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Re-admission &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;0 &#40;&#8722;9&#46;2&#59; 13&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Mortality &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;7&#46;0 &#40;&#8722;22&#46;1&#59; 18&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Hospitalization reasons &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infectious diseases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;28&#46;1 &#40;&#8722;32&#46;0&#59; &#8722;23&#46;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Aids-defining infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;30&#46;2 &#40;&#8722;36&#46;0&#59; &#8722;23&#46;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Psyquiatric illness</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;42&#46;7 &#40;&#8722;52&#46;0&#59; &#8722;31&#46;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Malignancies</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">115&#46;8 &#40;75&#46;4&#59; 165&#46;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Aids-defining tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;34&#46;8 &#40;&#8722;46&#46;0&#59; &#8722;21&#46;2&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiac diseases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">205&#46;6 &#40;116&#46;3&#59; 331&#46;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Digestive system diseases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">74&#46;8 &#40;53&#46;6&#59; 98&#46;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hepatic decompensations</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">103&#46;3 &#40;67&#46;6&#59; 146&#46;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chronic respiratory diseases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">96&#46;4 &#40;66&#46;3&#59; 131&#46;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Hospitalization units &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Internal medicine&#47;infectious diseases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;16&#46;7 &#40;&#8722;18&#46;9&#59; &#8722;14&#46;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Surgical units</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">108&#46;0 &#40;74&#46;6&#59; 147&#46;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Onco-hematology</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">116&#46;5 &#40;63&#46;4&#59; 186&#46;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Gynecology&#47;obstetrics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">58&#46;9 &#40;23&#46;3&#59; 104&#46;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pediatrics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;80&#46;7 &#40;&#8722;90&#46;2&#59; &#8722;62&#46;1&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Intensive care unit</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">200&#46;8 &#40;130&#46;0&#59; 293&#46;4&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Cause of in-hospital death &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">235&#47;453</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">218&#47;453</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">AIDS related illness&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">62&#46;1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">31&#46;7</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;49&#46;0 &#40;&#8722;59&#46;1&#59; &#8722;36&#46;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Aids related encephalopaty<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;70&#46;4 &#40;&#8722;84&#46;4&#59; &#8722;43&#46;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>MAI-MTB infection<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;61&#46;1 &#40;&#8722;78&#46;8&#59; &#8722;28&#46;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pneumocistis jirovecci pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;48&#46;1 &#40;&#8722;72&#46;5&#59; &#8722;2&#46;0&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Aids related malignancy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;4 &#40;&#8722;26&#46;4&#59; 127&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Disseminated candidiasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#8722;88&#46;0 &#40;&#8722;98&#46;5&#59; &#8722;6&#46;2&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Recurrent bacterial pneumoniae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;46&#46;1 &#40;&#8722;83&#46;5&#59; 76&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Wasting syndrome&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;1 &#40;&#8722;86&#46;3&#59; 112&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Non-AIDS related illness&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">37&#46;9</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">68&#46;3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">80&#46;5 &#40;49&#46;7&#59; 117&#46;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#40;02&#46;1&#41; Bacterial infection<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">66&#46;2 &#40;2&#46;9&#59; 168&#46;4&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#40;02&#46;1&#46;1&#41; Bacterial infection with sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">88&#46;6 &#40;5&#46;0&#59; 238&#46;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#40;03&#46;1&#46;1&#41; HCV with cirrhosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">115&#46;6 &#40;10&#46;5&#59; 320&#46;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">277&#46;3 &#40;55&#46;2&#59; 817&#46;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#40;16&#41;Violent death&#47;&#40;19&#41;substance abuse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#40;13&#41; Chronic obstructive lung disease<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">223&#46;4 &#40;&#8722;66&#46;1&#59; 2985&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#40;90&#41; Other causes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;46&#46;1 &#40;&#8722;83&#46;5&#59; 76&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of 6917 hospital admissions between periods &#40;1993&#8211;2002 and 2003&#8211;2013&#41;&#46;</p>"
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      "titulo" => "References"
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        0 => array:2 [
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            0 => array:3 [
              "identificador" => "bib0145"
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                            1 => "B&#46; Ledergerber"
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                            5 => "A&#46; d&#8217;Arminio Monforte"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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            1 => array:3 [
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                      "titulo" => "Causes of death among persons with AIDS in the era of highly active antirretroviral therapy&#58; New York City"
                      "autores" => array:1 [
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                            0 => "J&#46;E&#46; Sackoff"
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                  "host" => array:1 [
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                      "Revista" => array:6 [
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            2 => array:3 [
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                  "contribucion" => array:1 [
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                      "autores" => array:1 [
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                  "host" => array:1 [
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                      "Revista" => array:6 [
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              "identificador" => "bib0160"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "autores" => array:1 [
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                  ]
                  "host" => array:1 [
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                      "Revista" => array:6 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends on epidemiological&#44; virological&#44; and clinical features among newly diagnosed HIV-1 persons in Northwest Spain over the last 10 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Pernas"
                            1 => "A&#46; Mena"
                            2 => "A&#46; Ca&#241;izares"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jmv.24185"
                      "Revista" => array:6 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25777786"
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              "etiqueta" => "6"
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                0 => array:2 [
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                      "titulo" => "Thirty-day hospital readmission rate among adults living with HIV"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Berry"
                            1 => "J&#46;A&#46; Fleishman"
                            2 => "B&#46;R&#46; Yehia"
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                            4 => "A&#46;L&#46; Agwu"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/QAD.0b013e3283623d5f"
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                        "tituloSerie" => "AIDS"
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              "etiqueta" => "7"
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                    0 => array:2 [
                      "titulo" => "Trends in reasons for hospitalization in a multisite united states cohort of persons living with HIV&#44; 2001&#8211;2008"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "HIV Research Network"
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;A&#46; Berry"
                            1 => "J&#46;A&#46; Fleishman"
                            2 => "R&#46;D&#46; Moore"
                            3 => "K&#46;A&#46; Gebo"
                          ]
                        ]
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                    0 => array:2 [
                      "doi" => "10.1097/QAI.0b013e318246b862"
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                        "volumen" => "59"
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        "texto" => "<p id="par0170" class="elsevierStylePara elsevierViewall">This work was supported in part by grants from <span class="elsevierStyleGrantSponsor" id="gs1">Fondo de Investigaci&#243;n Sanitaria</span> &#40;CPII14&#47;00014&#44; PI10&#47;02166&#44; PI13&#47;02266&#44; CM13&#47;00328&#41;&#44; and <span class="elsevierStyleGrantSponsor" id="gs2">Fundaci&#243;n Profesor Novoa Santos&#44; A Coru&#241;a</span>&#46; We would like to thank Biobank of A Coru&#241;a &#40;SERGAS&#41; for providing us the technical&#44; ethical and legal advice necessary for the development of our research&#46;</p>"
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ISSN: 2529993X
Original language: English
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