Emergency room visits by older patients living with HIV: an approach based on the EDEN registry

To investigate the incidence, sociodemographic characteristics, baseline status and evolution of elderly people living with HIV infection (PLHIV) attended in Spanish hospital emergency departments (ED).

Patients included in the EDEN (Emergency Department and Elder Needs) registry, which includes all patients aged 65 or older attended in 52 Spanish EDs during 7 consecutive days in 2019, were analyzed. Two groups were constructed according to whether or not they had known HIV infection (PLHIV and non-LHIV). We collected 6 sociodemographic factors and 8 referring to the patient's baseline situation. We recorded whether the episode of ED care required hospitalization, intensive care unit (ICU) admission, prolonged ED and inpatient stay, and in-hospital mortality, as well as reconsultation to the ED, rehospitalization, and death from any cause during the 3 years after discharge. The sociodemographic and baseline characteristics and the evolution of patients in the PLHIV and non-PLHIV groups were compared.

Of 25,557 patients in the EDEN registry, 78 were PLHIV (0.30%, 95% CI 0.24% to 0.38%). The annual ED frequentation rate of PLHIV and non-PVHIV was 811 and 573 per 1000 population, respectively. The sociodemographic and baseline conditions were similar between PLHIV and non-PLHIV, with only age differing (younger PLHIV). Older PLHIV had severe comorbidity (27%), some type of functional limitation (27%) and cognitive impairment (11%). The most frequent ED diagnoses in PLHIV were pneumonia or lower respiratory tract infection (11%), heart failure or cardiogenic shock (8%) and joint and axial pain (6%), and in the non-HIV group there were no new diagnoses of HIV infection. 24.4% of PLHIV were hospitalized, 27.3% had a prolonged stay in the ED, 50% had prolonged hospitalization, 7.7% had in-hospital mortality, and reconsultation to the ED, hospitalization, and death during the 3 years post-discharge were 67%, 45.6%, and 21.7%, respectively. No outcome differed between PLHIV and non-PLHIV.

Older PLHIV have sociodemographic and baseline characteristics like the general population, but their rate of ED visits is higher. The severity of the episodes leading to this ED consultation is similar between PLHIV and non-PLHIV and long-term follow-up also shows no differences.