AIDS-related and non-AIDS causes of in-hospital death among people living with HIV: a multicenter retrospective study

Despite advances in antiretroviral therapy (ART), mortality remains an important concern among people living with HIV (PLWH). This study described the causes of in-hospital death and compared AIDS-related and non-AIDS-related deaths among 138 adults PLWH who died during hospitalization at 12 tertiary-care HIV centers in Türkiye between 2014 and 2025. Demographic, clinical, and HIV-related data were collected from medical records. Causes of death were classified as AIDS-related or non-AIDS-related using ICD-10-coded diagnoses and CDC/WHO AIDS-defining conditions. Overall, 138 in-hospital deaths were analyzed. AIDS-related deaths accounted for 56.5%. The leading AIDS-related causes were Pneumocystis jirovecii pneumonia, toxoplasmic encephalitis, and tuberculosis, whereas sepsis and respiratory conditions predominated among non-AIDS-related deaths. AIDS-related deaths were characterized by lower CD4 cell counts and more frequent AIDS-defining illness at diagnosis. Smoking (OR = 7.23, 95% CI 1.07–48.75, p = 0.042) and AIDS-defining illness at diagnosis (OR = 6.18, 95% CI 1.18–32.32, p = 0.031) were independently associated with AIDS-related rather than non-AIDS-related in-hospital death. AIDS-related causes remain prominent among in-hospital deaths despite the ART era. Earlier HIV diagnosis, timely ART initiation, and optimized prevention and management of opportunistic infections and comorbidities are essential to improve outcomes.