Causes of hospitalization among people living with HIV in a tertiary-care hospital in Bogotá, Colombia, 2018–2024

Background and objective Despite expanded access to antiretroviral therapy (ART), people living with HIV (PLWH) continue to experience high hospitalization rates, particularly in low- and middle-income countries. This study aimed to describe the causes of hospitalization in a cohort of PLWH treated at a high-complexity referral center in Bogotá, Colombia, and to assess variations across the pre-pandemic, pandemic, and post-pandemic periods of COVID-19. Methodology We conducted a retrospective cohort study including hospitalization episodes among adults with confirmed HIV infection between 2018 and 2024. Clinical characteristics, causes of hospitalization, and outcomes were compared across the epidemiological periods related to the COVID-19 pandemic. Results A total of 872 hospitalization episodes corresponding to 584 patients were analyzed. The median age was 34 years, and 89.1% were men. Although 68.7% of patients had a history of ART use, 54.8% were admitted with detectable viral load. Non–AIDS-defining causes predominated across all periods (61.8%), with a progressive increase from the pre-pandemic to the post-pandemic period (55.3%, 63.1%, and 70.1%, respectively). A sustained increase in hospitalizations due to mental health disorders was observed over time (4.3%, 4.6%, and 7.8%). Among AIDS-defining conditions, tuberculosis (15.8%) and Pneumocystis jirovecii pneumonia (14.9%) were the most frequent. Hospitalizations due to opportunistic infections were associated with longer length of stay (median 14 vs. 6 days; p < 0.001) and higher 30-day mortality (8.6% vs. 2.6%; p < 0.001) compared with non–AIDS-defining hospitalizations, with a proportional increase in events attributable to tuberculosis and Kaposi sarcoma. Conclusions An epidemiological transition towards non-AIDS-defining causes of hospitalization is evident, comparable to patterns observed in high-income countries; however, a substantial burden of tuberculosis, Kaposi sarcoma, and late HIV diagnosis persists, likely reflecting ongoing structural gaps in HIV care. Following the COVID-19 pandemic, an increase in hospitalizations related to mental health disorders was observed. Taken together, these findings highlight the urgent need to strengthen early diagnosis, active case finding, and tuberculosis prevention, as well as to enhance the implementation of comprehensive care models that improve retention in care for PLWH in low- and middle-income countries.