*Purpose: Despite the advent of highly effective anti-retroviral therapy, HIV remains a major health burden. Though life expectancy has improved, patients are now dying from non-HIV comorbidities such as cirrhosis. This study examined mortality trends of patients hospitalized with cirrhosis and HIV over time using a nationally representative hospital database.

*Methods: Hospitalized adults with cirrhosis, identified by a validated algorithm, were included using the Nationwide Inpatient Sample from 2000-2014. Discharges were weighted to give nationally-representative estimates. The primary outcome was inpatient mortality over time among patients with HIV and cirrhosis compared to patients with cirrhosis alone. Secondary outcomes included admissions for decompensating liver-related events and infection. Predictors for mortality, including infection-related mortality, were also determined by multivariable logistic regression controlling for covariates selected a priori.

*Results: Of the 6,142,750 weighted discharges included, 119,161 (1.9%) patients had cirrhosis and HIV. Inpatient mortality for those with HIV and cirrhosis decreased from 13.8% in 2000 to 6.1% in 2014 and is now equivalent to non-HIV.

Compared to those without HIV, patients with HIV and cirrhosis had fewer decompensating events including ascites, encephalopathy, and gastrointestinal bleeding (37% vs. 44%), but higher rates of infection (27% vs. 25%), both p<0.001. In multivariable analysis, HIV was an independent predictor of overall mortality (OR 1.66, 95% CI 1.58-1.73, p<0.001) and infection-related mortality (OR 1.55, 95% CI 1.45-1.65).

*Conclusions: Inpatient mortality in patients with cirrhosis and HIV has dramatically decreased and now equals that of non-HIV patients. However, HIV still remains an independent predictor of mortality and infection-related mortality, and points to a need for early identification and effective treatment of infections within this high risk hospitalized population.

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