José Manuel Ramos, Héctor Pinargote (Internal Medicine Department, General University Hospital of Alicante, ISABIAL and Miguel Hernández University of Elche), Marouane Menchi-Elanzi (Emergency Department, General University Hospital of Alicante-ISABIAL), Asunción Martínez (Center of Operations Research, Miguel Hernández University, Elche), Gregorio González (History of Science and Documentation Department, University of Valencia), de Carmen Mendoza (Laboratory of Internal Medicine, Puerta de Hierro Research Institute, University Hospital, Majadahonda), Pablo Barreiro (Tropical Medicine Unit, Carlos III-La Paz University Hospital, Madrid), Félix Gómez, Octavio Jorge Corral and Vicente Soriano (UNIR Health Sciences School and Medical Center, Madrid)

Abstract: Background: The prognosis of HIV infection dramatically improved after the introduction of triple antiretroviral therapy 25 years ago. Herein, we report the impact of further improvements in HIV management since then, looking at all hospitalizations in persons with HIV (PWH) in Spain. Methods: A retrospective study using the Spanish National Registry of Hospital Discharges. Information was retrieved since 1997 – 2018. Results: From 79 647 783 nationwide hospital admissions recorded during the study period, 532 668 (0.67%) included HIV as diagnosis. The mean age of PWH hospitalized increased from 33 to 51 years (P < 0.001). The rate of HIV hospitalizations significantly declined after 2008. Comparing hospitalizations during the first (1997 – 2007) and last (2008 – 2018) decades, the rate of non-AIDS illnesses increased, mostly due to liver disease (from 35.9 to 38.3%), cardiovascular diseases (from 12.4 to 28.2%), non-AIDS cancers (from 6.4 to 15.5%), and kidney insufficiency (from 5.4 to 13%). In-hospital deaths occurred in 5.5% of PWH, declining significantly over time. Although most deaths were the result from AIDS conditions (34.8%), the most frequent non-AIDS deaths were liver disease (47.1%), cardiovascular events (29.2%), non-AIDS cancers (24.2%), and kidney insufficiency (20.7%). Conclusion: Hospital admissions in PWH significantly declined after 2008, following improvements in HIV management and antiretroviral therapy. Non-AIDS cancers, cardiovascular events and liver disease represent a growing proportion of hospital admissions and deaths in PWH.