Hospitalization Rates and Associated Factors Among Older Adults With HIV in the United States

Literature on hospitalization incidence and risks among people with HIV (PWH) in the current antiretroviral therapy era is limited.

Using data (2017-2021) on PWH ≥ 40 years of age from the Advancing Clinical Therapeutics Globally HAILO Study, cumulative probabilities of first hospitalization were estimated using Kaplan-Meier plots. Cox proportional hazards regression was used to identify factors associated with first hospitalization.

Among 891 participants (median age 50 years; 80% male), 38 with prevalent hospitalization at baseline were excluded. The remaining 853 participants had a follow-up of 2721 person-years, during which 170 (20%) had at least 1 hospitalization event (incidence rate, 6.2 per 100 person-years [95% confidence interval [CI] = 5.4-7.3]). The leading causes of hospitalization included infections (14%), elective surgery (13%), cardiovascular conditions (12%), and lung problems (12%). Former and current smokers had higher hospitalization risk (adjusted hazard ratio [aHR] 1.51 [95% CI = 1.03-2.20], aHR 1.85 [95% CI = 1.24-2.76], respectively) than never smokers. Hospitalization risk was higher for participants who were frail (aHR 2.31 [95% CI = 1.38-3.86]) compared with those who were robust (not frail), and lower in the Western region compared with the Northeast region (hazard ratio = 0.55, 95% CI: 0.32-0.93). Hospitalization risk was also higher for participants with diabetes (aHR 1.69 [95% CI = 1.13-2.52]).

We observed a lower hospitalization risk than in previous studies among PWH. Interventions to reduce smoking, prevent frailty, and improve diabetes management may further lower hospitalization risk.