Impact of Social Vulnerability on Critical Illness Outcomes in HIV-Positive Individuals
Overview
This multicenter cohort study evaluated the influence of social precariousness on clinical presentation and mortality outcomes in HIV-positive patients admitted to intensive care units. Despite distinct clinical features among precarious patients, social vulnerability was not independently associated with increased in-hospital or 1-year mortality.
Background
People living with HIV (PHIV) admitted to intensive care units (ICUs) have experienced evolving clinical outcomes due to advances in HIV care, including early diagnosis and effective antiretroviral therapy. However, social precariousness—such as homelessness, undocumented migration, and socioeconomic deprivation—remains a barrier to consistent HIV care and viral suppression. Undocumented migrants represent a particularly vulnerable subgroup with higher risks of delayed diagnosis and opportunistic infections. The impact of these social determinants on critical illness outcomes in PHIV has not been well characterized.
Data Highlights
Characteristic
Precarious Patients (n=136)
Nonprecarious Patients (n=803)
Proportion of undocumented migrants
5.7%
Not applicable
Proportion of other precarious patients
8.7%
Not applicable
In-hospital mortality
17.8%
17.8%
1-year mortality
24.2%
24.2%
Adjusted odds ratio for in-hospital mortality (precarious vs nonprecarious)
1.04 (95% CI, 0.98–1.10)
Reference
Adjusted odds ratio for 1-year mortality (precarious vs nonprecarious)
0.89 (95% CI, 0.54–1.48)
Reference
Key Findings
Among 939 HIV-positive ICU admissions, 14.5% were classified as socially precarious.
Undocumented migrant patients were younger, had fewer comorbidities, and more frequently presented with previously unknown HIV infection or AIDS-defining opportunistic infections.
Other precarious patients exhibited lower rates of viral suppression despite similar access to combination antiretroviral therapy and were more often admitted for bacterial sepsis.
Overall in-hospital mortality was 17.8%, and 1-year mortality was 24.2%, with no significant difference between precarious and nonprecarious groups after adjustment.
Precariousness was not independently associated with increased risk of death during hospitalization or at 1 year, including in undocumented migrants.
Clinical Implications
Clinicians should recognize that socially precarious HIV-positive patients admitted to ICUs may present with distinct clinical profiles, such as late HIV diagnosis and opportunistic infections, reflecting chronic inequities in care access. However, social vulnerability alone should not be considered a prognostic factor for mortality in critical illness among PHIV. Efforts to improve early HIV diagnosis and viral suppression in vulnerable populations remain essential to reduce critical illness burden.
Conclusion
Social precariousness influences the clinical presentation of critical illness in HIV-positive patients but does not independently affect short- or long-term mortality outcomes in ICU settings. Addressing chronic inequities in HIV care access is vital to improving overall health in this population.
References
Source Article 2024 -- Impact of Social Vulnerability on Critical Illness Outcomes in HIV-Positive Individuals: A Multicenter Cohort Analysis
