Social precariousness and the outcome of critical illnesses in people living with HIV: a multicenter cohort study

Background Social precariousness hinders access to the cascade of care in people living with HIV (PLHIV). Its impact on the clinical presentation and outcome of critical illnesses in this patient population is unknown. Methods We included all PLHIV admitted over the 2015-2020 period in 12 university-affiliated intensive care units (ICU) in France. Precarious patients encompassed undocumented migrants, homeless, and individuals facing other forms of socioeconomic deprivation. Precarious and non-precarious PLHIV were compared for baseline characteristics and reasons for admission. The effect of precariousness on in-hospital mortality (primary endpoint) and one-year mortality (secondary endpoint) was measured through logistic regression. Results Among the 939 included PLHIV, 136 (14.5%) were classified as precarious (migrants, 5.7%; others, 8.7%). Compared to non-precarious patients, (i) migrants were younger, had fewer comorbidities, and were more often admitted with previously unknown HIV infection and/or for AIDS-defining opportunistic infections, (ii) precarious patients other than migrants presented with lower rates of viral suppression (despite similar access to combination antiretroviral therapies) and were more often admitted for bacterial sepsis. Overall in-hospital and one-year mortality rates were 17.8% and 24.2%, respectively. Precariousness was not independently associated with in-hospital mortality (adjusted odd ratio [aOR], 1.04; 95% confidence interval [CI], 0.98-1.10) or one-year mortality (aOR, 0.89; 95% CI 0.54-1.48), including when analyzing migrants separately. Conclusion Precarious PLHIV requiring ICU admission have particular clinical features that likely reflect chronic inequities in access to HIV care. However, precariousness is probably not linked with a higher hazard of death during the index hospital stay or at one year.