Differences in Mortality Between Treatment-Naive and Treatment-Discontinuing Hospitalized Individuals With Advanced...

Advanced human immunodeficiency virus (HIV) disease is a major cause of morbidity and mortality in people with HIV in Latin America. It remains unclear whether mortality differs between people with advanced HIV who are treatment naive (TN) and those who have discontinued antiretroviral treatment (TD). We compared mortality differences between hospitalized TN and TD individuals with advanced HIV.

All adults hospitalized for advanced HIV disease (CD4 count <200 cells/μL or with AIDS-defining events) at a tertiary center in Mexico City between January 2015 and December 2022 were included. The primary outcome was 1-year mortality following hospitalization. Secondary outcomes were overall mortality and 30-day mortality.

Four hundred seventy hospitalizations occurred in 299 adults with advanced HIV. Of these, 214 (72%) were TN at the time of admission, while 85 (28%) were TD. The median CD4 cell count was 76 cells/μL and AIDS-related infections accounted for most of the deaths. No differences were found between the groups regarding hospitalization days, CD4 cell count, or comorbidities. TD were more likely to have acquired HIV by sexual transmission (P = .009). One-year mortality was significantly higher in the TD group (24% vs 8%; P = .008). The overall mortality was also higher among TD individuals (P = .008). Multivariate analysis revealed an independent association between treatment discontinuation and mortality (hazard ratio, 2.08 [95% confidence interval, 1.14-3.78]).

Treatment discontinuation is associated with worse clinical outcomes when compared to TN patients. Future research should focus on understanding the reasons for these findings to develop public health strategies to prevent disruption of the continuum of care.