Incidence of ICU Admissions for Individuals With HIV and AIDS-Defining Illness Admissions in Texas

Introduction: Over the last 15 years, highly active anti-retroviral therapy (HAART) for human immunodeficiency virus (HIV) became increasingly potent and accessible. We investigated whether advances in HIV care translated into a lower incidence of admissions for Acquired Immunodeficiency Syndrome (AIDS)-defining illnesses and a lower incidence of Intensive Care Unit (ICU)-level admissions for individuals with HIV.


Methods: The Texas Inpatient Public Use Data Files from 2006 to 2023 included over 54 million hospital discharge records from every non-federal hospital in the state. We plotted annual hospital discharges with an ICU stay containing an HIV primary or secondary diagnosis at a state-level population incidence rate per 100,000 people (HIV-ICU stays). Alongside, we also plotted hospital discharges with a principal diagnosis of an AIDS-defining illness. Joinpoint regression was used to assess significant trends and changes in trend over time. A maximum of 3 Joinpoints were permitted for a parsimonious model. The regressions used a parametric confidence interval and the calculated standard error.


Results: The incidence of HIV-ICU stays increased linearly from 11.2 per 100,00 Texans in 2006 to 14.3 in 2018 (p < 0.001), then changed direction (p=0.02) and decreased to 10.1 by 2021 (p=0.048). From 2021 to 2023, there was a significant departure from the prior slope (p=0.02), but no significant linear trend identified (p=0.141). The incidence of AIDS-defining illnesses decreased linearly from 8.7 per 100,000 Texans in 2006 to 3.68 in 2021 (p < 0.001). From 2021 to 2023, there was no significant linear trend (p=0.464) nor significant departure from the prior slope (p=0.08).


Conclusions: HIV-ICU admissions gradually increased through 2018 then declined sharply. While the HIV-ICU incidence was ultimately similar in 2006 and 2023, AIDS-defining illness admissions decreased by 50% over this time. The discordance suggests ICU patients with HIV may have an evolving risk profile. Perhaps differences in practice patterns, patient demographics, and/or medication side effects may relate. Further research should investigate whether HIV is more commonly a critical ailment or background comorbidity in the ICU and whether trainees are still adequately prepared to treat AIDS-defining illnesses given declining volume.