By Henry Neondo
neondohenry@yahoo.com
Klerksdorp, South Africa — A new South African study has found that adults living with HIV who are virally suppressed but require hospitalisation still face a significant risk of death within a month of discharge, highlighting persistent gaps in HIV and tuberculosis (TB) care despite treatment success.
The study, published in the January 2026 issue of the journal AIDS examined adults with HIV admitted to a public tertiary hospital in Klerksdorp between October 2023 and September 2024. All participants had suppressed viral loads—an indicator that antiretroviral therapy (ART) is working effectively.
Researchers led by Samuel J. Starke, Rush Medical College, Chicago, screened 1,245 hospitalised patients and enrolled 99 people living with HIV who had viral loads below 1,000 copies/ml. The median age was 45 years, and more than half (56%) were women.
Despite viral suppression, the findings reveal a troubling reality: more than one in four hospital admissions (27.3%) were due to AIDS-defining illnesses, with tuberculosis accounting for the majority. Nearly 44% of participants had advanced HIV disease (AHD), defined by very low CD4 counts or the presence of serious AIDS-related conditions.
Most concerning was the 30-day mortality rate of 12.1%, with half of the deaths occurring after patients had already been discharged from hospital. The majority of those who died were under the age of 50 and had undetectable viral loads at the time of admission.
“This challenges the common assumption that viral suppression alone guarantees protection from severe illness and death,” the authors note.
Tuberculosis remains a leading threat
TB emerged as the single most important cause of hospitalisation and death, underscoring its continued role as South Africa’s leading killer of people living with HIV. The findings suggest that TB is often diagnosed late, even among patients who are engaged in HIV care and adherent to ART.
The study also identified longer duration since HIV diagnosis (more than 10 years) and low haemoglobin levels at admission as factors strongly associated with death within 30 days. These indicators may reflect chronic illness, undetected co-infections, or gaps in long-term HIV monitoring.
Implications for South Africa’s HIV response
South Africa has made major progress in scaling up ART and achieving viral suppression, with millions of people living healthy lives on treatment. However, the study highlights that hospitalised patients represent a particularly vulnerable subgroup that current HIV programmes may be failing to protect.
Experts say the findings point to the need for stronger integration between HIV and TB services, especially for people who appear stable on ART but may have declining immune function.
The authors call for earlier TB screening, expanded use of TB preventive therapy, and closer post-discharge follow-up, particularly during the critical first month after hospitalisation.
“Survival should not depend solely on viral load results,” the study concludes. “Clinicians and health systems must remain vigilant for advanced HIV disease and TB—even among patients who appear well controlled.”
As South Africa pushes toward ending AIDS as a public health threat, the study serves as a reminder that viral suppression is necessary but not sufficient. Without earlier detection of opportunistic infections and better continuity of care after hospital discharge, preventable deaths will continue to occur.