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Hospitalization Rates and Associated Factors Among Older Adults With HIV in the United States
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Download the PDF here
Download the PDF here
JAIDS Aug 1 2026
The average age of people with HIV (PWH) has been increasing, largely because of the success of antiretroviral therapy (ART). However, even with effective ART, HIV continues to contribute to increased comorbidity burden, elevated risk for some infections, and mortality. Likewise, advancing age is associated with increased susceptibility to disease. Thus, the combination of chronic HIV and advanced age is likely to result in an increased risk of severe disease requiring hospitalization.
DISCUSSION
In this large, well-characterized US cohort of PWH age ≥40 years, 20% of participants had at least 1 hospitalization over 5 years of follow-up, with an incidence rate of 6.2 per 100 person-years. The most common causes of hospitalization were lung problems, elective surgery, infections, and cardiovascular conditions. The risk factors for hospitalization were former or current smoking status, frail status, region of residence, and diabetes.
In summary, we observed a lower risk of hospitalization compared with previous studies of PWH, with infection-related and cardiopulmonary problems the leading causes of hospitalization. We also identified several potentially modifiable factors, suggesting that interventions for smoking cessation, preventing or attenuating frailty, and managing comorbidities such as diabetes may further reduce hospitalization among older PWH.
Results:
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 with those who were robust (not frail), and lower in the Western region compared with the Northeast region (hazard ratio = 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]).
Causes of Hospitalization
Overall, the most common participant-reported causes of hospitalization were infections (14.0%), elective surgery (13.1%), cardiovascular conditions (12.3%), and lung problems (11.9%) (Fig. 2). Among elective surgeries, orthopedic and joint procedures were the most frequent, accounting for 32%, followed by spine surgeries (23%), cardiovascular interventions (16%), gastrointestinal or abdominal surgeries (13%), urologic surgery (6%), and other procedures (10%). The leading causes of hospitalization varied by age group (see Figure S1, Supplemental Digital Content, http://links.lww.com/QAI/C683). Among individuals aged 40-49 years, infections (17.4%) and lung problems (16.3%) were most common. In the 50-59 age group, elective surgery (17.0%) and cardiovascular conditions (17.0%) were the most frequently reported. Among those aged ≥60 years, infections and injury/accident were the most common causes of hospitalization, accounting for 18.4% and 15.8%, respectively.
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