Non-AIDS Hospitalizations Overtook AIDS-Defining Illnesses in Bogotá HIV Cohort
In a tertiary-care hospital in Bogotá, hospitalization among people living with HIV was driven more often by conditions outside the classic AIDS framework than by opportunistic infection alone. Across 872 hospitalization episodes involving 584 patients treated between 2018 and 2024, non-AIDS-defining causes accounted for 61.8% of admissions overall and increased steadily across the study periods, from 55.3% before the pandemic to 63.1% during the pandemic and 70.1% afterward.
The pattern is clinically important. It suggests that inpatient HIV care in a middle-income setting is no longer defined solely by late-stage immunosuppression, even though uncontrolled infection remains common in the admitted population. A cohort with a median age of 34 years and a striking male predominance, 89.1%, presented with a broad mix of complications that reflected both persistent immune dysfunction and the wider burden of psychiatric and medical comorbidity.
Viral Rebound Remained Common Despite Prior Antiretroviral Exposure
Prior antiretroviral therapy exposure was common, with 68.7% of patients having a history of ART use. Even so, 54.8% of admissions occurred in the setting of a detectable viral load. That combination points to a familiar but unresolved problem in HIV care: treatment exposure does not always translate into durable virologic control, and inpatient admission often becomes the setting where poor adherence, treatment interruption, resistance, social instability, or delayed outpatient follow-up becomes visible.
The bedside implication is direct. Hospitalized patients with HIV in this cohort were not mostly presenting after a single catastrophic AIDS event; many were living with partially treated disease, making admission a marker of fragmented longitudinal care rather than a simple reflection of diagnosis status alone.
Tuberculosis and Pneumocystis Still Anchored the AIDS Burden
Among AIDS-defining conditions, tuberculosis was the leading diagnosis at 15.8%, followed closely by Pneumocystis jirovecii pneumonia at 14.9%. Those two entities remain among the most consequential opportunistic infections in settings where HIV care must coexist with high community exposure to tuberculosis and where delayed immune recovery can leave patients vulnerable to severe pulmonary disease.
Hospitalizations for opportunistic infections carried a substantially longer length of stay, with a median of 14 days compared with 6 days for other causes. Even without extrapolating beyond the data, the clinical logic is clear: opportunistic infections often require prolonged diagnostic workup, microbiologic confirmation, intravenous therapy, oxygen support, or management of complications before discharge becomes safe. A long admission is not just a utilization metric; it usually reflects a deeper physiologic injury and a longer recovery arc.
Mental Health Admissions Rose Across the Pandemic Periods
One of the most striking shifts in the cohort was the sustained rise in hospitalizations for mental health disorders, which increased from 4.3% pre-pandemic to 4.6% during the pandemic and 7.8% post-pandemic. The trend was modest in absolute percentages, but its consistency across periods gives it practical weight.
Psychiatric illness in HIV rarely exists in isolation. Depression, substance use, trauma, medication nonadherence, stigma, housing insecurity, and disrupted access to care can converge in ways that deepen both virologic failure and acute medical risk. In a referral hospital, the admission may be triggered by behavior, safety concerns, or decompensation, yet the downstream effect reaches much further: missed ART, delayed evaluation of infection, and reduced retention in care. The increase in psychiatric admissions therefore reads as more than a coding shift; it reflects a widening gap between chronic infectious disease management and mental health support.
The Pandemic Changed the Mix of Admissions More Than the HIV Population Itself
Across the pre-pandemic, pandemic, and post-pandemic periods, the hospitalization profile moved away from classic opportunistic disease and toward non-AIDS causes. The progression from 55.3% to 63.1% to 70.1% for non-AIDS-defining admissions suggests a changing inpatient case mix over time rather than a single isolated spike.
Several mechanisms could explain that drift without requiring any one cause to dominate. COVID-19-era disruptions likely affected outpatient continuity, medication access, mental health, and early presentation to care. At the same time, the broader survival gains of ART can shift the clinical burden toward chronic and noninfectious complications, even in a cohort where virologic suppression remains incomplete for many. The result is a hospital population that looks increasingly heterogeneous, with infectious, psychiatric, and general medical causes overlapping in the same service line.
What This Cohort Says About HIV Inpatient Care in Middle-Income Settings
The findings from Bogotá describe a hospital population that sits at the intersection of ongoing HIV transmission, incomplete viral suppression, tuberculosis risk, and widening mental health needs. The age distribution, with a median of 34 years, argues against the mistaken assumption that HIV hospitalization is mainly a problem of older age and long-standing degenerative comorbidity. These were relatively young adults admitted for serious illness, often with detectable viremia and a history of ART exposure that had not translated into consistent control.
For hospital teams, this means inpatient HIV care cannot be organized around opportunistic infection alone. Tuberculosis and Pneumocystis jirovecii pneumonia remain central, but the growing share of admissions due to psychiatric disease and other non-AIDS conditions requires broader coordination between infectious diseases, internal medicine, psychiatry, and social care. In practical terms, discharge planning has to account for adherence support, mental health follow-up, and linkage back to longitudinal HIV treatment, not just completion of acute antimicrobial therapy.
The study is limited to a single high-complexity referral center, so the case mix may not represent community hospitals or outpatient HIV programs elsewhere in Colombia or Latin America. Even so, the signal is hard to ignore: in this cohort, hospitalization among people living with HIV increasingly reflected the burden of chronic, mixed, and often preventable disease rather than AIDS alone. The remaining question is not whether opportunistic infections still matter—they clearly do—but how health systems can reduce the growing share of admissions driven by incomplete HIV control and mental health deterioration.