Online Poster Portal

Specialty: Infectious Disease

Keywords: Advanced HIV Disease, Opportunistic Infections, Southern Brazil, Global Health

Background:

Porto Alegre in Southern Brazil experiences a disproportionately high burden of HIV/AIDS compared with other Brazilian capitals. We evaluated AIDS-related admissions to a tertiary referral center to characterize regional characteristics of the epidemic.

Objective:

To clarify the composition and burden of HIV and WHO defined advanced HIV disease (AHD) admissions at a tertiary facility in Porto Alegre, RS from 2015-2024.

Methods:

In a retrospective cohort study of adults hospitalized in the infectious disease ward between 2015-2024 with confirmed HIV, we analyzed data extracted from institutional records to characterize demographics, admission diagnoses, clinical parameters, and hospitalization outcomes. Generalized estimating equations identified predictors of severe outcome (SO), defined as intensive care unit admission or in-hospital mortality among the full, AHD, and non-AHD cohorts.

Results:

Among 3,596 admissions with HIV (2,376 patients), 1,553 patients met AHD criteria, 23% of whom were newly diagnosed during admission. Although the full cohort was 65% of white race and 53% male, non-white and female admissions increased significantly over time (p=0.021, p=0.009), with women becoming the prevailing sex by study conclusion. Mean age at AHD admission increased from 40 in 2015 to 43 years in 2024 (p<0.001). Annual rates of AHD and new admission diagnoses of HIV decreased moderately over time (p=0.002, p=0.014 respectively), yet the overall AHD in-hospital mortality rate (7% ) remained stable (p=0.296). Stratification by SO revealed accelerated rates of feminization (OR 1.083 [1.020, 1.129], p=0.009) and a loss of the downtrends in AHD and new diagnoses. Notably, 81% of SO occurred in the AHD cohort.

Primary reasons for admission for patient with AHD included opportunistic infections (OI’s 58%): tuberculosis (TB, 21%), disseminated cytomegalovirus (11%), toxoplasma encephalitis (11%), esophageal candidiasis (9%), and pneumocystis pneumonia (9%). While most OIs declined, TB remained stable with overall OI rates unchanging, though OI rate showed mild increase within the SO cohort (p=0.040). Bacterial pneumonia was th eleading cause of admission for non-AHD (12%) and second for AHD (14%) cohorts  Primary causes of death were respiratory failure (35%), septic shock (33%), opportunistic infections (18%), and malignancy (13%).

In multivariate GEE models, sepsis (IRR 2.88) and nosocomial infections (IRR 2.41) were the strongest predictors of SO (p<0.001). Total population risk was significantly higher for CD4 <50 (IRR 2.64) and new HIV diagnosis (IRR 1.37). AHD risk was driven by PCP (IRR 2.40), PML (IRR 1.67), and malignancy (IRR 2.47). In contrast, the non-AHD group was most impacted by malignancy (IRR 4.11) and sepsis (IRR 3.18), though this group saw a significant annual risk reduction (IRR 0.93; p=0.045) not observed in AHD.

Conclusions:

Despite mild decreases advanced HIV disease and new diagnoses, the burden of severe outcomes and AHD in-hospital mortality in Southern Brazil remains high and unchanging. Inpatient demographics appear to be shifting toward an aging, predominantly female, and non-white population. The enduring burden of opportunistic infections among patients with severe outcomes suggest that late diagnosis and barriers to care continue to drive mortality. Findings underscore the need for prevention efforts such as counseling, testing and HIV PrEP targeting all populations in south Brazil regardless of perceived risk and bolstering of treatment adherence efforts for individuals living with HIV.