AIDS-Related Illnesses Lead Global HIV Hospitalizations

TOPLINE:

AIDS-related illnesses continued to be the leading cause of hospitalization, accounting for 42% of the admissions, with tuberculosis being the most frequent illness. This pattern was consistent across all age groups.

METHODOLOGY:

• Researchers conducted an updated meta-analysis of 110 studies to determine the causes of hospitalizations and the risk for in-hospital mortality among people living with HIV globally from 2014 to 2023.
• In order to ensure comprehensive geographical coverage, the researchers searched published literature from eight databases: Ovid (Medline ALL, Embase Classic and Embase, and Global Health), Clarivate Analytics Web of Science (Core Content and SciELO), EBSCOhost (CINAHL Complete and Africa-Wide Information), and Global Index Medicus.
• Studies that reported information on the cause of admission and demographics, such as region, age, gender, duration of data collection, study setting, median CD4 count, current antiretroviral therapy use, HIV viral load, and number of deaths, were included.
• The prevalence of diseases leading to hospital admissions was estimated.

TAKEAWAY:

• Overall, 100,628 hospital admissions from 91,114 participants (68.7% were males) were included, and 35 studies were from Africa and 31 from Europe. In-hospital deaths constituted 16.2% of cases.
• The most common cause of hospital admissions worldwide across all age groups was AIDS-related illnesses (42%; 95% CI, 35%-49%), including tuberculosis (19%), Pneumocystis jirovecii pneumonia (7%), and cryptococcal disease (5%). The second most common cause of admissions was bacterial infections (26%; 95% CI, 20%-33%).
• AIDS-related illnesses were predominant causes of admission in all regions except Southeast Asia and North America, where bacterial infections were the most common cause.
• Malnutrition was a common cause of hospital admissions in children (31%; 95% CI, 11%-63%), among studies from Africa.

IN PRACTICE:

“Given the increases, globally, in the proportion of people receiving effective ART [antiretroviral therapy], the findings from this systematic review remind us that even with improved ART access, people living with HIV continue to get sick, are hospitalised, and die from HIV-related causes,” the author of a commentary wrote.

SOURCE:

This study was led by Rachael M. Burke, PhD, London School of Hygiene & Tropical Medicine in London, England. It was published online on March 26, 2025, in The Lancet HIV.

LIMITATIONS:

This study’s limitations included the quality of underlying data, particularly diagnostics and definitions for each cause of admission. Most studies did not describe definitions, diagnostic methods, or rationale or type of schema. Differences in diagnostic access and imprecision due to poorly documented diagnostics and definitions over time and across regions may have affected condition reporting. The systematic review design limited the ability to break down findings by subcohorts, like individual CD4 cell count.

DISCLOSURES:

This study received funds from the Bill & Melinda Gates Foundation. Few authors reported receiving funding from the UK National Institute for Health and Care Research and the US Centers for Disease Control and Prevention. One co-author reported receiving salary support from Janssen. Two co-authors served on Data Safety Monitoring Boards for trials involving hospitalized people living with HIV.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.