1. Slide 1 Healthcare Utilization and Mortality associated with HIV and HCV: How to address the burden of liver disease Susanna Naggie 1,2, Lawrence Park 1, Ziad Gellad 1,2, Kevin Schulman 1,2, Charles Hicks 1, John McHutchison 3, Andrew Muir 1,2 1 Duke University Medical Center, 2 Duke Clinical Research Institute, 3 Gilead Sciences No relevant disclosures

2. Slide 2 Background Approximately 30% of people LWHIV are co- infected with HCV There has been a rise in HCU among HCV infected individuals ALLRT Cohort reported 70% higher HCU rates Sherman et al CID 2002;34:831-37. Linas et al JVH 2010; 1-7.

3. Slide 3 Objectives Compare inpatient healthcare utilization metrics among HIV/HCV co-infected and HIV and HCV mono-infected patients o Hospital Admission o Mortality Identify primary reasons for utilization metrics Determine risk factors associated with healthcare utilization metrics

4. Slide 4 Methods Nationwide Inpatient Sample (NIS) o Largest all-payer inpatient care database in US o 20% stratified sample of hospitals from 37 states o Accounts for approximately 8 million admission/yr o Sampling stratification Study population o 1994-2007 o Identified by ICD-9 codes among all 15 diagnoses o HIV/HCV; HIV; HCV

5. Slide 5 Methods Study variables and outcomes o Primary: admissions, cost of stay o Secondary: reason for admission, death, LOS o Variables: age, race, payer status, gender, hospital characteristics (region, bedsize) o Reason for admissions defined by ICD-9 code categories using primary diagnosis Statistical Analysis: Descriptive included means and proportions. Multivariable regression models adjusted for sampling scheme and US consumer Price Index for Medical Care

6. Slide 6 Results: Primary Outcomes Total Hospital Admissions Total Inpatient Healthcare Spending

7. Slide 7 Results: Secondary Outcomes Length of StayIn-Hospital Mortality

8. Slide 8 Reasons for Admission GroupReasons for Admission HIV 36% Non-HIV Infection 16% Psychiatric Sub Abuse 12% CVD/GI 7%/7% Trauma 4% HCV Liver/GI 25% Psychiatric Sub Abuse 19% Infection 13% CVD 13% Trauma 7% HIV/HCV HIV 29% Non-HIV Infection 15% Liver/GI 14% Psychiatric Sub Abuse 13% CVD 8%

9. Slide 9 Reasons for Death GroupReasons for Death HIV 87% Infection 9% CVA 2% Pancreatitis 1% Renal 1% HCV Liver 63% Infection 23% Resp failure 7% Renal 4% CVA 3% HIV/HCV HIV 68% Liver 18% Infection 9% Resp Failure 4% Renal 1%

10. Slide 10 Conclusions The burden of healthcare resource utilization has decreased for HIV infected individuals but increased significantly for HCV infected individuals HCV infection is associated with higher inpatient healthcare costs than HIV although both infections carry increased burden and higher mortality than other co-morbidities Psychiatric disease and substance abuse are a leading cause of inpatient HCU in all groups Liver disease remains a leading cause of HCU and death in the HIV/HCV co-infected