Informing WHO global guidelines for advanced HIV disease
Published: 16 June 2026
At the request of the World Health Organization (WHO), Professor Peter MacPherson and a multinational team led an analysis of cause of death and risk of death for people living with HIV admitted to hospital.
Advanced HIV disease is the major cause of AIDS-related deaths among people living with HIV.
At the request of the World Health Organization (WHO), Professor Peter MacPherson and a multinational team led an analysis of cause of death and risk of death for people living with HIV admitted to hospital.
Understanding HIV deaths
Since around 1995 in Europe and North America, and 2003 in other regions, access to HIV care, including antiretroviral treatment (ART), has increased substantially. While improved ART-access has saved millions of years of life, around a third of people living with HIV still present to healthcare with advanced HIV disease. Hospitalization remains common among people living with HIV who experience a very high risk of death during hospital admission and in the weeks following discharge.
Understanding the range of causes of illness and death among hospitalized people living with HIV is crucial for informing approaches to opportunistic infection prophylaxis and early detection strategies for life-threatening communicable and non-communicable diseases.
What the analysis found
Sixty seven studies were identified involving over 59,000 participants reporting risk of death among hospitalized people living with HIV between 2014 and 2023.
The overall risk of in-hospital death was 16% i.e. one in six people living with HIV who were hospitalized, died.
There was substantial regional variability, with mortality risk highest among adults in Africa (19%) and among adults in intensive care units (44%).
Among 40 studies reporting cause of death in 6,838 participants, AIDS-related conditions predominated (72% of deaths), including tuberculosis deaths (27% of deaths). Bacterial infections were the second leading cause (25% of deaths).
There was no clear evidence of improving in-hospital survival over time in most regions between 2000 and 2023, though data suggested possible modest improvements in Africa.
Despite advances in HIV treatment, AIDS-related illnesses and bacterial infections remain the leading causes of in-hospital death among people living with HIV. These findings underscore the critical need to prioritize high-quality hospital care for opportunistic infections to reduce AIDS-related deaths.
WHO global guidelines
This analysis supports WHO’s global guidelines for advanced HIV disease which were published in December 2025. These updated guidelines respond to the need for better approaches to identify advanced HIV disease, improve the poor outcomes of people living with HIV being discharged from hospital, and provide updated guidance for treatment for Kaposi’s sarcoma through evidence-informed recommendations.
Professor Peter MacPherson said "Despite large increases in the number of people receiving life-saving treatment for HIV, for people with HIV who are admitted to hospital, the risk of death remains unacceptably high, and hasn’t changed over the last 20 years. This shows that we need urgent investment in developing new, better diagnostic tests and treatments for the main infectious killers such as tuberculosis and bacterial infections. We also need more research to understand why people with HIV admitted to hospital are at such high risk of death, and how we can prevent hospital admission in the first place."
This work was funded by the Bill and Melinda Gates Foundation through a grant to the WHO.
First published: 16 June 2026