Despite expanded access to antiretroviral therapy (ART), people living with HIV (PLWH) continue to have substantial hospitalization rates, particularly in low- and middle-income countries. This study aimed to describe causes of hospitalization in a cohort of PLWH treated at a high-complexity referral center in Bogotá, Colombia, and to evaluate changes in causes across the pre-pandemic, pandemic, and post-pandemic periods of COVID-19.
The authors conducted a retrospective cohort study that included hospitalization episodes among adults with confirmed HIV infection between 2018 and 2024. Clinical characteristics, primary causes of hospitalization, and outcomes were collected and compared across epidemiological periods related to the COVID-19 pandemic. Specific data elements reported in the abstract include total hospitalization episodes, patient demographics, ART history, viral load status at admission, classification of causes (AIDS-defining versus non-AIDS-defining), and selected outcomes such as length of stay and 30-day mortality. Details beyond these items (for example, exact inclusion/exclusion criteria, data sources, or statistical methods) were not reported in the abstract.
A total of 872 hospitalization episodes corresponding to 584 patients were analyzed. The median age of admitted patients was 34 years, and 89.1% were men. Regarding antiretroviral exposure, 68.7% of patients had a history of ART use; however, 54.8% were admitted with a detectable viral load.
Overall, non-AIDS-defining causes predominated, representing 61.8% of hospitalizations. The proportion of non-AIDS-defining admissions rose across the pandemic-related periods: 55.3% in the pre-pandemic period, 63.1% during the pandemic, and 70.1% in the post-pandemic period.
A sustained increase in hospitalizations due to mental health disorders was observed over time, with proportions of 4.3% pre-pandemic, 4.6% during the pandemic, and 7.8% post-pandemic.
Among AIDS-defining conditions, the most frequent diagnoses were tuberculosis (15.8% of AIDS-defining hospitalizations) and Pneumocystis jirovecii pneumonia (14.9%). There was a proportional increase in events attributable to tuberculosis and Kaposi sarcoma within the spectrum of AIDS-defining causes during the study period.
Hospitalizations for opportunistic infections were associated with worse short-term clinical outcomes compared with non-AIDS-defining hospitalizations: median length of stay was longer (14 days versus 6 days), and 30-day mortality was higher (8.6% versus 2.6%). Both differences were statistically significant in the reported analysis (p < 0.001).
The pattern described in this Bogotá cohort indicates an epidemiological shift toward non-AIDS-defining causes of hospitalization, a pattern noted by the authors to be comparable with trends reported in high-income countries. At the same time, the persistence of tuberculosis, Kaposi sarcoma, and frequent late HIV diagnosis signals continuing structural gaps in HIV care within this low- and middle-income setting.
The observed rise in mental health–related hospitalizations following the COVID-19 pandemic highlights the pandemic’s potential indirect effects on the health needs of PLWH. The high proportion of patients admitted with detectable viral load despite prior ART exposure emphasizes challenges in viral suppression and retention in care.
Based on these findings, the authors underscore the need to reinforce programs for early HIV diagnosis and active case finding, strengthen tuberculosis prevention and management, and implement comprehensive care models that improve retention and outcomes for PLWH. These interventions target both the persistent burden of opportunistic infections and the growing contribution of non-AIDS conditions, including mental health disorders.
In this tertiary-care referral cohort in Bogotá from 2018 to 2024, non-AIDS-defining causes became the majority cause of hospitalization and increased over time, while tuberculosis, Kaposi sarcoma, and other AIDS-defining conditions continued to account for a substantial proportion of admissions and were associated with longer stays and higher 30-day mortality. The study authors conclude that urgent efforts are needed to enhance early diagnosis, tuberculosis prevention, and comprehensive care strategies to improve retention and reduce morbidity and mortality among PLWH in low- and middle-income settings.
(Conflict of interest: the authors declared no competing interests.)