Trends and Causes of Hospitalization Among People With HIV in Korea: A 20-Year Observational Study

The widespread use of antiretroviral therapy (ART) has shifted a change in hospitalization patterns among people with HIV. However, long term trends and causes of hospitalization among people with HIV (PWH) in Korea remain underexplored. This study aimed to investigate 20-year trends in hospitalization rates and causes among PWH.

We retrospectively analyzed hospitalization data from 803 PWH aged ≥ 18 years who received care at the university-affiliated hospital from 2001 to 2020. Hospitalization data were examined across five 4-year intervals. Hospitalization rates per 100 person-years (PY) were estimated using generalized estimating equation models with a Poisson distribution, adjusting first for sex and age and then baseline CD4 T cell count and HIV viral load. Cox regression identified predictors of first hospitalization.

Over 3,998 PY, 593 hospitalizations occurred among 322 patients. Unadjusted all-cause hospitalization rates declined from 92.3 to 8.6 per 100 PY, driven by significant reductions in AIDS-defining illnesses (-79.0% per period; 95% confidence interval [CI], -94.8 to -63.1) and non-AIDS infections (-48.4% per period; 95% CI, -63.3 to -33.5). Maternal conditions increased from 0 to 0.67 per 100 PY, with a mean change of 91.3.% per period (95% CI, 41.3-141.2), whereas most of the other chronic conditions and trauma/injury remained stable. Fully adjusted models demonstrated similar trends in most of the categories. Anal condyloma emerged as a leading causes of hospitalization in the later periods. Multivariate analysis revealed that age ≥ 50 years (adjusted hazard ratio [aHR], 1.42; 95% CI, 1.05-1.92), CD4 counts < 100 cells/mm³ (aHR, 2.48; 95% CI, 1.74-3.53), and HIV RNA > 100,000 copies/mL (aHR, 1.61; 95% CI, 1.13-2.30) at enrollment were associated with a higher hospitalization risk.

Hospitalization rates among Korean PWH have declined substantially over two decades, primarily driven by a decline in opportunistic infections, attributable to earlier diagnosis and expanded ART access. However, persistent AIDS-related illnesses and the high proportion of non-AIDS-defining cancers diagnosed at advanced stage highlight the ongoing need for earlier HIV detection and a stigma-free healthcare environment that promotes care engagement for PWH.