Trends in hospitalizations and deaths in HIV-Infected patients in Spain over two decades.

Background The prognosis of HIV infection dramatically improved after the introduction of triple antiretroviral therapy 25 years ago. Herein, we report the impact of further improvements in HIV management since then, looking at all hospitalizations in persons living with HIV (PLWH) in Spain. Methods Retrospective study using the Spanish National Registry of Hospital Discharges. Information was retrieved since 1997 to 2018. Results From 79,647,783 nationwide hospital admissions recorded during the study period, 532,668 (0.67%) included HIV as diagnosis. The mean age of PLWH hospitalized increased from 33 to 51 years-old (p < 0.001). The rate of HIV hospitalizations significantly declined after 2008. Comparing hospitalizations during the first (1997-2007) and last (2008-2018) decades, the rate of non-AIDS illnesses increased, mostly due to liver disease (from 35.9% to 38.3%), cardiovascular diseases (from 12.4% to 28.2%), non-AIDS cancers (from 6.4% to 15.5%) and kidney insufficiency (from 5.4% to 13%). In-hospital deaths occurred in 5.5% of PLWH, declining significantly over time. Although most deaths were the result from AIDS conditions (34.8%), the most frequent non-AIDS deaths were liver disease (47.1%), cardiovascular events (29.2%), non-AIDS cancers (24.2%) and kidney insufficiency (20.7%). Conclusion Hospital admissions in PLWH significantly declined after 2008, following improvements in HIV management and antiretroviral therapy. Non-AIDS cancers, cardiovascular events and liver disease represent a growing proportion of hospital admissions and deaths in PLWH.