Social Precariousness and the Outcome of Critical Illnesses in People with HIV: A Multicenter Cohort Study
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By
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Piotr Szychowiak
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Thierry Boulain
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Étienne de Montmollin
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Jean-François Timsit
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Alexandre Elabbadi
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Laurent Argaud
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Stephan Ehrmann
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Nahema Issa
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Emmanuel Canet
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Frédéric Martino
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Fabrice Bruneel
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Jean-Pierre Quenot
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Florent Wallet
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Élie Azoulay
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François Barbier
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November 12, 2025
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Clinical Scorecard: Impact of Social Vulnerability on Critical Illness Outcomes in HIV-Positive Individuals: A Multicenter Cohort Analysis
At a Glance
| Category | Detail |
|---|
| Condition | Critical illness in people living with HIV (PHIV) |
| Key Mechanisms | Social precariousness affects access to HIV care cascade, viral suppression, and clinical presentation in critical illness |
| Target Population | HIV-positive adults admitted to intensive care units, including undocumented migrants and socioeconomically deprived individuals |
| Care Setting | University-affiliated intensive care units in France |
Key Highlights
- Precarious PHIV include undocumented migrants, homeless, and socioeconomically deprived individuals (14.5% of cohort).
- Migrants were younger, had fewer comorbidities, and more often admitted with unknown HIV or AIDS-defining infections.
- Precarious non-migrant PHIV had lower viral suppression rates despite similar cART access and were more often admitted for bacterial sepsis.
Guideline-Based Recommendations
Diagnosis
- Classify PHIV as precarious if undocumented migrant, homeless, incarcerated, or experiencing socioeconomic deprivation.
- Assess HIV viral load and CD4 count within 6 months of ICU admission.
Management
- Continue combination antiretroviral therapy (cART) according to International Antiviral Society guidelines.
- Provide targeted care addressing social vulnerabilities to improve HIV care continuum.
Monitoring & Follow-up
- Monitor in-hospital and 1-year mortality outcomes in PHIV admitted to ICU.
- Track viral suppression status and opportunistic infections during ICU stay.
Risks
- Precariousness is not independently associated with increased in-hospital or 1-year mortality in PHIV ICU patients.
- Social vulnerability correlates with delayed HIV diagnosis and impaired viral suppression.
Patient & Prescribing Data
HIV-positive adults admitted to ICU, including precarious subgroups
Despite similar access to cART, precarious non-migrant patients show lower viral suppression, indicating need for enhanced adherence support.
Clinical Best Practices
- Identify and address social determinants of health in PHIV admitted to ICU to optimize HIV care outcomes.
- Recognize that precariousness influences clinical presentation but does not independently worsen mortality outcomes.
- Ensure early HIV diagnosis and sustained viral suppression to reduce critical illness severity.
References
