Clinical Presentation and Mortality Among Hospitalized People Living With HIV at a Tertiary Care Institute in Mumbai, India

Introduction: Despite global advancements in antiretroviral treatment and the widespread adoption of universal antiretroviral therapy (ART) initiation, hospitalization among people living with HIV (PLHIV) infection remains a persistent concern in many settings. A substantial proportion of hospitalized patients present with low CD4 lymphocyte count, opportunistic infections, or complications that arise from treatment interruption or untreated HIV infections. With increasing age among this population, the presence of non-communicable diseases (NCDs) has also become more common, making clinical management more complex. Despite overall progress in HIV care, severe illness requiring hospitalization continues to be driven by opportunistic infections associated with immune suppression, especially tuberculosis. This study sought to assess the demographic and clinical characteristics, causes of hospitalization, and hospital mortality among PLHIV, with a specific comparison between ART-experienced and treatment-naïve patients admitted to a tertiary care institute in Mumbai, India. Methods: This cross-sectional study reviewed hospital records of 325 PLHIV inpatients in a tertiary care institute from June 2022 to May 2024. Demographic characteristics, ART status and duration, CD4 lymphocyte count at time of admission, causes of hospitalization, and patient outcomes were extracted from medical records. Causes of hospitalization were categorized as acquired immunodeficiency syndrome (AIDS)-defining illness (ADI) or non-ADI. Appropriate descriptive and inferential statistical analyses were performed. Results: A total of 325 hospitalized PLHIV were included; 187 (57.5%) were on ART and 138 (42.5%) were treatment naïve. The median age was 44 years (IQR: 19). ADIs accounted for 147 (45.2%) of hospitalizations, with tuberculosis being the predominant cause. Treatment-naïve patients were more likely to present with severe immunosuppression, with 73 (52.9%) having CD4 lymphocyte counts of less than 200 cells/µL compared to 41 (21.9%) among ART-experienced patients. ADI-related hospitalizations were significantly associated with younger age, male sex, unmarried status, lower CD4 lymphocyte counts, and shorter duration on ART. Non-ADI hospitalizations were more common among older patients and those on ART for longer durations. Hospital mortality was seen in 28 (8.6%), predominantly among people with advanced HIV disease and ADIs, with tuberculosis being the most frequent opportunistic infection. Conclusion: Despite widespread ART availability, ADIs, particularly tuberculosis, remain major drivers of hospitalization and hospital mortality among PLHIV in this setting. Simultaneously, the growing burden of non-ADIs and NCDs among ageing PLHIV highlights an ongoing epidemiological transition and the need for integrated, age-responsive HIV care models.