Trends in hospitalizations in adults with HIV infection in Spain over 25 years

Given the current high efficacy of antiretroviral therapy and the availability of prophylactic medications, the spectrum of illnesses requiring hospitalization in people with HIV (PWH) has evolved over time. All hospitalizations with a diagnosis of HIV and/or AIDS at the National Registry of Hospital Discharges were retrospectively examined in Spain from 1997 to 2022. There were 610,912 admissions in PWH. Male represented 73%. Mean age at admission was 43.2 years-old and increased from 33.5 years in 1997 to 53.2 in 2022 (<i>p</i> < 0.0001). Overall, hospitalizations declined by 36.3%. AIDS was present in 71.1% of admissions, with 31.4% diagnosed during the same admission. Across three periods (1997-2007, 2008-2015, 2016-2022), the proportion of admissions with AIDS decreased (76.1%, 68.6%, and 64%), as did new AIDS diagnoses (36.2%, 28.3%, and 23.3%) (<i>p</i> < 0.001). Among those newly diagnosed with AIDS, 78.8% had opportunistic infections (OIs), and 19.5% AIDS-associated cancers. OIs declined (84.7%, 73.1%, and 54.8%), while neoplasms increased (14.1%, 24.4%, and 31.5%) (<i>p</i> < 0.001). In-hospital mortality was 5.4% and decreased (6%, 5.2% and 4.5%) (<i>p</i> < 0.001). Hospitalizations and mortality among PWH in Spain have decreased over 25 years. While OIs dropped 23.3%, AIDS-related cancers rose by 20%. Mean age at admission reached 53.2 years in 2022.