Ongoing crisis across the HIV care continuum: high mortality among PWH admitted to the ICU in an urban safety-net hospital in the South

We present a retrospective study of people with HIV (PWH) admitted to the medical intensive care unit (MICU) of an 862-bed academic, safety-net hospital. We aimed to determine the characteristics of ICU admissions among PWH, measure the mortality in this population and identify predictors of mortality. All patients ≥ 18 years old with a diagnosis of HIV infection admitted to the MICU between January 1, 2017 and December 31, 2019 were included. A total of 195 ICU admissions occurred during the study period. The mean age was 46.2 years, 77.4% were male and the majority were people of color. Overall, 125 (64.8%) patients had CD4<200 cells/mL and 12 (6.7%) were newly diagnosed with HIV. ICU mortality was 21.5% and hospital mortality was 24.6%. High APACHE score and CD4<200 were independent predictors of ICU mortality. Our three-year retrospective analysis of PWH admitted to the ICU in a large urban safety-net hospital in the US South during the recent modern ART era identified high ICU- and hospital mortality. We also identified a higher mortality risk at each step of the HIV care cascade, reinforcing the importance of proactive interventions including expanded HIV testing and implementation of strategies which improve engagement in care, ART adherence and virologic suppression.