Despite the availability of antiretroviral therapy (ART) in Brazil, significant challenges persist in the care of people living with HIV (PLHIV). Social determinants of health affect HIV-related outcomes, leading to hospitalizations. This study aimed to characterize the hospitalization profile of PLHIV in a state in southeastern Brazil.

A retrospective cohort of PLHIV hospitalized in an infectious disease reference hospital between October 2021 and April 2024. Sociodemographic and clinical characteristics were compared according to ART status and gender identity, using chi-square/Fisher’s exact tests (categorical variables) and the Wilcoxon test (continuous variables).

A total of 1,877 PLHIV were included: 52.3% had never started ART or initiated it within 90 days prior to hospitalization; 10.8% were not on ART; and 36.9% had at least one dispensation in the previous six months. The median age was 41 years (IQR 32–52), with most being cisgender men (62.1%) and Black/brown (70.9%). Moreover, 32.6% had only primary education, and lower educational levels were associated with ART discontinuation. PLHIV not on ART or with recent initiation had higher HIV-RNA viral loads and lower CD4+ counts, a pattern also observed among those without ART in the previous six months. The most prevalent opportunistic infections (OIs) were tuberculosis (33.9%), Pneumocystis pneumonia (15.1%), toxoplasma encephalitis (10.9%), cryptococcosis (5.6%), cytomegalovirus infection (3.4%), histoplasmosis (3.2%), and Kaposi’s sarcoma (3.1%). OIs accounted for 59.7% of hospitalizations; other causes included pneumonia (29.7%), COVID-19 (4.6%), urinary infection (3.9%), neoplasms (3.2%), and mpox (2.0%). Hospital mortality was higher among those who discontinued ART (29.1% vs 18.1%, p < 0.01). Transgender women were younger (median 35 [IQR 29–44] vs 41 [IQR 32–52] years) and had higher self-discharge rates (20% vs 5.5% overall).

The study highlights persistent challenges faced by Brazil’s Unified Health System (SUS) in ensuring effective care for PLHIV. Late diagnosis and ART interruption, leading to poorer clinical outcomes, underscore the urgent need to address the political and social inequalities that sustain the AIDS epidemic, particularly among the most vulnerable populations.