Comorbidity Clusters and Immune Profiles in Hospitalized People with HIV: A Retrospective Analysis at a Tertiary Care Center in Eastern China.

Background: Antiretroviral therapy (ART) has shifted hospitalization causes in people with HIV (PWH) from AIDS-related to non-AIDS-related events. Data on comorbidity profiles and clinical characteristics of hospitalized PWH remain limited. Therefore, this study analyzes comorbidities and clinical characteristics of PWH in eastern China to understand the regional burden of comorbidities and inform clinical practice and regional hospital management.

Methods: This retrospective study included 593 hospitalized PWH. Demographic, clinical, and laboratory data, along with HIV-related medical history, were extracted from medical records. Diagnoses of comorbidities were based on established criteria. Clinical characteristics were compared across comorbidity groups.

Results: Among 593 participants, comorbidities were categorized into three groups: Non-AIDS-Defining Diseases (NADs, n=241), Opportunistic Infections (OI, n=204), and Malignancies (n=111). PWH with malignancies were significantly older (median age 58 years) than those with OI (43 years, p=0.001) or NADs (42 years, p=0.001). Patients with OIs had a significantly shorter duration since HIV diagnosis and ART initiation compared with the NADs and malignancy groups. Immunological analysis showed that the NADs group had higher median CD4+ T cell counts [413.5 (234-584) cells/μL] and CD4/CD8 ratios [0.75 (0.41-1.18)] compared with the OI and malignancy groups. AIDS-Defining Malignancies (ADMs) cases had significantly lower CD4+ T cell counts than Non-AIDS-Defining Malignancies (NADMs) cases [134.5 (97-313.75) vs 306 (200.25-503.00) cells/μL, p=0.002]. Multivariate logistic regression analysis established that a CD4/CD8 ratio below 0.5 independently associated with ADMs [adjusted OR 3.47 (95% CI 1.37-8.77), P=0.004].

Conclusion: NADs have emerged as the leading cause of hospitalization among PWH. For PWH who receive stable ART, remain at risk for NADs, warranting regular screening to prevent advanced disease. Routine monitoring of CD4+ T cell counts and CD4:CD8 ratios may facilitate improved cancer and OI screening strategies for individuals with persistently low ratios of CD4/CD8 or ART-naïve.