Research square · 2026
Factors Associated with ICU Admission and In-Hospital Mortality in a Decade of HIV/AIDS Admissions to a Tertiary Hospital at the Epicenter of the Brazilian Epidemic (2015-2024).
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Zywica Maxwell, Hernandez Christopher Justin, Fonseca Pedro M, Noal Andressa, Giovelli Alexandre, Cambou Mary Catherine, Maier Weston, Segura Eddy, Varella Ivana Rosângela Dos Santos, Santos Breno, de Melo Marineide Gonçalves, Nielsen-Saines Karin
Аннотация
BACKGROUND: South Brazil experiences disproportionately high HIV/AIDS morbidity and mortality. To characterize the regional epidemic profile, we evaluated HIV hospitalizations over time.
METHODS: In a retrospective cohort of adults hospitalized with HIV between 2015-2024 to a tertiary institution in Porto Alegre, data extracted from institutional records was analyzed for hospitalization outcomes. Severe outcomes (SO) were defined as critical care admission or in-hospital mortality.
RESULTS: Among 5218 infectious disease hospitalizations, 3596 were due to HIV (69%), encompassing 2376 participants; 1555 (65%) met WHO stage III/IV criteria for advanced HIV disease (AHD). Most patients were white (65%), male (53%), urban (65%). Among AHD participants, 77% had not completed high school. From 2015 to 2024, median age of patients increased from 41 to 44 years (p < 0.001). Declines in new HIV diagnoses following admission (p = 0.017) and AHD admissions (p = 0.015) occurred over time; new HIV diagnoses in AHD patients remained unchanged (p = 0.107). AHD case fatality rate of 11% remained stable (p = 0.287). Tuberculosis was the most prevalent reason for admission (21%, n = 488) followed by bacterial pneumonia (14%, n = 312) in AHD patients. Bacterial pneumonia was leading cause of admission in non-AHD patients (12%, n = 151). OIs and nosocomial infections were implicated in over half of in-hospital mortalities. Factors associated with SO were sepsis, pneumocystis pneumonia, nosocomial infections, non-opportunistic malignancy, tuberculosis, new HIV diagnoses and/or CD4 < 50 cells/mm 3 .
CONCLUSION: In south Brazil, late HIV diagnoses and barriers to care appear to drive mortality. Targeted efforts to diagnose and engage patients in care earlier are warranted to prevent severe outcomes.
METHODS: In a retrospective cohort of adults hospitalized with HIV between 2015-2024 to a tertiary institution in Porto Alegre, data extracted from institutional records was analyzed for hospitalization outcomes. Severe outcomes (SO) were defined as critical care admission or in-hospital mortality.
RESULTS: Among 5218 infectious disease hospitalizations, 3596 were due to HIV (69%), encompassing 2376 participants; 1555 (65%) met WHO stage III/IV criteria for advanced HIV disease (AHD). Most patients were white (65%), male (53%), urban (65%). Among AHD participants, 77% had not completed high school. From 2015 to 2024, median age of patients increased from 41 to 44 years (p < 0.001). Declines in new HIV diagnoses following admission (p = 0.017) and AHD admissions (p = 0.015) occurred over time; new HIV diagnoses in AHD patients remained unchanged (p = 0.107). AHD case fatality rate of 11% remained stable (p = 0.287). Tuberculosis was the most prevalent reason for admission (21%, n = 488) followed by bacterial pneumonia (14%, n = 312) in AHD patients. Bacterial pneumonia was leading cause of admission in non-AHD patients (12%, n = 151). OIs and nosocomial infections were implicated in over half of in-hospital mortalities. Factors associated with SO were sepsis, pneumocystis pneumonia, nosocomial infections, non-opportunistic malignancy, tuberculosis, new HIV diagnoses and/or CD4 < 50 cells/mm 3 .
CONCLUSION: In south Brazil, late HIV diagnoses and barriers to care appear to drive mortality. Targeted efforts to diagnose and engage patients in care earlier are warranted to prevent severe outcomes.