Hospitalization rates and associated factors among older adults with HIV in the US.

INTRODUCTION: Literature on hospitalization incidence and risks among people with HIV (PWH) in the current antiretroviral therapy era is limited. METHODS: Using data (2017 to 2021) on PWH ≥40 years of age from the Advancing Clinical Therapeutics Globally (ACTG) HAILO Study, cumulative probabilities of first hospitalization were estimated using Kaplan-Meier plots. Cox proportional hazards regression was used to identify factors associated with first hospitalization. RESULTS: Among 891 participants (median age 50 years; 80% male), 38 with prevalent hospitalization at baseline were excluded. The remaining 853 participants had a follow-up of 2721 person-years, during which 170 (20%) had at least 1 hospitalization event (incidence rate, 6.2 per 100 person-years [95% CI=5.4-7.3]). The leading causes of hospitalization included infections (14%), elective surgery (13%), cardiovascular conditions (12%), and lung problems (12%). Former and current smokers had higher hospitalization risk (adjusted hazard ratio [aHR] 1.51 [95% CI=1.03-2.20], aHR 1.85 [95% CI=1.24-2.76], respectively) than never smokers. Hospitalization risk was higher for participants who were frail (aHR 2.31 [95% CI=1.38-3.86]) compared to those that were robust (not frail), and lower in the Western region compared with the Northeast region (HR= 0.55, 95% CI: 0.32-0.93). Hospitalization risk was also higher for participants with diabetes (aHR 1.69 [95% CI=1.13-2.52]. CONCLUSION: We observed a lower hospitalization risk than in previous studies among PWH. Interventions to reduce smoking, prevent frailty, and improve diabetes management may further lower hospitalization risk.