Of the 798 individuals, 74% were MSM, 9.5% were heterosexual men and 16.3% were women. Median age (IQR) at baseline was 46 (40–51) years.
Causes of hospitalisation
Of the 274 hospitalisations, 174 had one cause assigned, 69 had two, 14 had three, 9 had four, 5 had five causes and no information was available for 3 (415 causes in total). Figure 1 shows the distribution of causes.
The seven most common ICD-10 categories, which cover at least one cause for 196 (72%) of hospitalisations, are described below.
Circulatory diseases were the most commonly documented causes, involving 16.8% (n = 46) of admissions. This included: heart disease (n = 20 including: infective and acute pericarditis, mitral valve insufficiency, cardiomyopathy, cardiac arrest, cardiac arrhythmias, and heart failure); ischaemic heart disease (n = 10 including: angina pectoris, myocardial infarctions and chronic ischaemic heart disease); pulmonary embolism (n = 5); cerebrovascular disease (n = 3); atherosclerosis and other diseases of the arteries/arterioles (n = 4); diseases of veins, lymphatic vessels and lymph nodes (n = 4). Other causes (n = 2) were chronic rheumatic heart disease (mitral valve disease) and hypertension.
Digestive diseases were the second most documented cause, present in 13.1% (n = 36) of hospitalisations. Most common were diseases of: liver (n = 8 including: alcoholic hepatitis, hepatic failure, liver cirrhosis); gallbladder, biliary tract and pancreas (n = 6); intestines (n = 7 including: anal abscesses, fistula of intestines, constipation, megacolon); oesophagus, stomach and duodenum (n = 4); other digestive diseases (n = 7). There were three admissions due to non-infective enteritis and colitis, three due to acute peritonitis, two due to appendicitis, and one due to hernia.
Respiratory diseases were documented for 11.7% of admissions (n = 32). The specific conditions were: influenza and pneumonia (n = 20 including: seasonal flu, bacterial pneumonia, viral pneumonia); chronic lower respiratory diseases (n = 9 including: chronic obstructive pulmonary disease, asthma); unspecified acute lower respiratory infection (n = 5); other respiratory diseases (n = 5); upper respiratory infections (n = 3).
In 11.0% of hospitalisations (n = 30), infectious diseases were a documented cause. This included HIV-related infections (n = 10 including: mycobacterial infection, cytomegalovirus, pneumocystis jirovecii pneumonia, tuberculosis, encephalopathy, wasting syndrome, haematological and immunological abnormalities); STIs (n = 6: syphilis, gonorrhoea, Chlamydia, anogenital warts); protozoal diseases (n = 5); intestinal infectious diseases (n = 5), mycoses (n = 4). Other causes (n = 11) were related to herpes zoster, infections of central nervous system, other bacterial diseases or infectious agents, TB of nervous system.
Of the hospitalisations for injury, poisoning and other consequences of external causes (n = 29, 10.6%), poisoning by drugs, medicines and biological substances was listed in 16 cases. Four were related to antiretrovirals; other substances included: non-steroidal anti-inflammatory drugs (NSAID), antiepileptic, sedative-hypnotic, antidepressants, psychostimulants, anticoagulants, calcium-channel blockers, antacids and anti-gastric secretion drugs, oxytocic drugs. Five of the hospitalisations due to poisoning were additionally recorded as intentional self-harm by self-poisoning with drugs/alcohol). Eight hospitalisations were related to complications of surgical and medical care including: infection or other procedure complications, and complications of internal orthopaedic prosthetic devices, implants and grafts. There were 19 injury-related causes (head, neck, thorax, abdomen, lower back, lumbar spine and pelvis, elbow and forearm, hip and thigh, knee and lower leg, ankle and foot and foreign body in the genitourinary tract).
For 27 (9.9%) admissions for genitourinary diseases, documented causes were: diseases of the urinary system (n = 7 including: urinary tract infections and urethral fistulas), renal tubule-interstitial diseases (n = 5); diseases of male genital organs (n = 5). Other causes included renal failure, urolithiasis, non-inflammatory disorders of female genital tract and glomerular disease.
There were 25 hospitalisations (9.1%) related to neoplasms; almost all (87% of causes) were malignant. The most common affected regions of those were: digestive organs (n = 10), ill-defined secondary and unspecified sites (n = 6), respiratory and intrathoracic organs (n = 4), genital organs (n = 2 female and n = 1 male), Kaposi’s sarcoma (n = 1), melanoma (n = 1), lip, oral cavity and pharynx (n = 1). Non-malignant neoplasms were documented for four admissions.
The remaining 12 ICD-10 categories were each mentioned in less than 9% of the total admissions (Fig. 1).
Of note, there were 11 hospitalisations related to mental health problems. Four were related to depressive episodes; three to use of alcohol, opioids or other stimulants; one to non-drug/alcohol induced delirium; four unspecified.
In total, 27 hospitalisations (10%) had one or more AIDS-defining illness (ADI) documented: pneumonia (n = 12); encephalopathy (n = 3); mycobacterium avium complex (n = 2); lymphoma (n = 2); cryptococcal meningitis (n = 2); Kaposi sarcoma (n = 2); pneumocystis pneumonia (n = 2); cytomegalovirus (n = 1); tuberculosis and toxoplasmosis (n = 1).
Characteristics of patients at admission
At admission, median age was 52 years; median CD4 count was 510/µl; median CD4 nadir was 113/µl. Half (51%) of hospitalised individuals had a previous AIDS diagnosis and 21% had viral non-suppression (median viral load: 738 copies/ml, IQR:162 − 22,653) at admission).
For injury/poisoning, more women (28%), particularly Black African women (21%), were hospitalised compared to the proportion overall (17% and 12% respectively). Infectious and genitourinary disease admissions had a higher proportion of heterosexual men (30% respectively), particularly of Black African ethnicity, compared to other causes. Median age at hospitalisation was somewhat lower for injury/poisoning than the other common causes.
Individuals hospitalised for digestive, infectious diseases or neoplasms had lower median CD4 counts compared to other causes. A prior AIDS diagnosis was much less prevalent in those hospitalised for injury/poisoning (28%) compared to other common causes and hospitalisations overall (51%); similarly CD4 nadir was higher for the injury/poising cause. Almost half of individuals admitted for infectious diseases had detectable viral load at hospitalisation compared to 21% of individuals admitted overall. Individuals admitted for circulatory, respiratory or infectious diseases were more likely to be current smokers compared to other causes.
For ADI hospitalisations, the median (IQR) current and nadir CD4 counts at admission were 560 (339–700) and 69 (17–202) cells/µl respectively, 26 (96%) were on ART and 11 (41%) had viral load > 50 copies/ml. The median time since HIV diagnosis was 20 years (IQR:13–26).
The median duration of hospitalisation was 5 days, varying from 4 to 8 across the seven common causes.