Evolving Trends in Late HIV Diagnosis: Increasing Frequency but Improved Survival and Reduced Opportunistic Infections in a 10-Year Hospital-Based Cohort

Introduction Late HIV diagnosis increases hospitalization and mortality, but evidence from Latin America remains limited. This study assessed the frequency of late HIV diagnosis among hospitalized patients and described temporal trends in clinical characteristics, opportunistic infections, and short-term outcomes in the Colombian Caribbean. Methods A retrospective cohort study was conducted at a tertiary referral hospital (2014-2023), including adults with late HIV diagnosis defined as CD4 + T-cell counts <350 cells/µL or an AIDS-defining illness. Data was obtained from medical records, and 6-month mortality was verified through the national health insurance database. Multivariable logistic regression assessed predictors of 6-month mortality, and temporal trends were evaluated (chi-square for trend). Results Eighty-one patients met the criteria for late HIV diagnosis. Most were male (74.1%) with a median age of 42 years (interquartile range [IQR] 32-50), low socioeconomic status, and limited education. Opportunistic infections were frequent, particularly infectious diarrhea (46.9%), Pneumocystis jirovecii pneumonia (24.7%), and tuberculosis (16%). Median CD4 + T-cell count was 46 cells/µL (IQR 21–112). Intensive care unit (ICU) admission occurred in 27.2%, with in-hospital and 6-month mortality of 13.5% and 32.1%, respectively. CD4 + T-cell count <100 cells/µL independently predicted 6-month mortality (OR 7.9, 95% CI 1.48-42.8; p=0.01). Over time, patients with late HIV diagnosis increased, while opportunistic infections (p=0.009), severe immunosuppression (p=0.02), and in-hospital (p=0.02) and 6-month mortality (p=0.003) declined significantly. Conclusions These findings underscore the substantial burden and evolving pattern of late HIV diagnosis, with increasing cases but improved short-term outcomes. Early detection and targeted interventions remain essential in this population.