Social Precariousness and the Outcome of Critical Illnesses in People with HIV: A Multicenter Cohort Study

Social precariousness hinders access to the cascade of care in people with HIV (PHIV). Its impact on the clinical presentation and outcome of critical illnesses in this patient population is unknown.

We included all PHIV admitted over the 2015 to 2020 period in 12 university-affiliated intensive care units in France. Precarious patients encompassed undocumented migrants, homeless, and individuals facing other forms of socioeconomic deprivation. Precarious and nonprecarious PHIV were compared for baseline characteristics and reasons for admission. The effect of precariousness on in-hospital mortality (primary endpoint) and 1-year mortality (secondary endpoint) was measured through logistic regression.

Among the 939 included PHIV, 136 (14.5%) were classified as precarious (migrants, 5.7%; others, 8.7%). Compared to nonprecarious patients, (1) migrants were younger, had fewer comorbidities, and were more often admitted with previously unknown HIV and/or for AIDS-defining opportunistic infections; and (2) precarious patients other than migrants presented with lower rates of viral suppression (despite similar access to combination antiretroviral therapies) and were more often admitted for bacterial sepsis. Overall in-hospital and 1-year mortality rates were 17.8% and 24.2%, respectively. Precariousness was not independently associated with in-hospital mortality (adjusted odds ratio, 1.04; 95% confidence interval, .98-1.10) or 1-year mortality (adjusted odds ratio, .89; 95% confidence interval, .54-1.48), including when analyzing migrants separately.

Precarious PHIV requiring intensive care unit admission have particular clinical features that likely reflect chronic inequities in access to HIV care. However, precariousness is probably not linked with a higher hazard of death during the index hospital stay or at 1 year.