Predictors of Initial and Recurrent Hospitalization Among People Living with HIV: A Longitudinal Cohort Study

Hospitalization remains a significant concern among people living with HIV (PLWH), particularly when admissions are recurrent. While prior research has identified psychiatric comorbidities and HIV disease severity as predictors of initial hospitalization, less is known about the factors that drive repeated hospitalizations in the modern treatment era. This study examined psychiatric, demographic, and HIV-related predictors of first and subsequent hospitalizations using longitudinal data from 9,793 PLWH with follow-up care in the Bronx, New York, between 2016 and 2023. Two primary outcomes (i.e., time to non-psychiatric hospitalization and time to HIV-related hospitalization) were modeled independently using Prentice, Williams, and Peterson gap-time models. Recent mental health visits and diagnoses, substance use-related diagnoses, lower CD4 T-cell count, and detectable viral load were each associated with increased risk of first and subsequent hospitalization. Prior mental health care engagement was associated with reduced risk of non-psychiatric hospitalization. Demographic disparities were also observed: women, older people, and patients with Medicaid had higher risk for hospitalization, while those with commercial insurance had lower risk. These findings extend previous research on first-time hospitalization in this population by explicitly distinguishing predictors of first versus subsequent hospitalizations, and underscore the need for integrated psychiatric care, sustained viral suppression, and tailored outpatient support to reduce avoidable hospitalizations.