Background: Despite the global improvement in PLWHIV care, HIV/AIDS continues to constitute a significant proportion of hospitalisation and a leading cause of illness and death in developing countries. Objectives: The study aimed to identify the causes of admission, determine the in-hospital outcome, and identify factors associated with poor outcome in PLWHIV in a tertiary hospital in Cameroon (Buea Regional Hospital (BRH)). Methods: A 5-year retrospective study was carried out at the BRH. Files of admitted HIV patients aged 18 or older from January 2017 to December 2021 were included. Demographic, laboratory, and clinical data were extracted. Each admission was assigned a reason for admission and an outcome. Data were analysed using SPSS version 25, and multiple logistic regression analysis was used to identify factors associated with poor outcome. Statistical significance was set at a p-value <0.05, with a confidence interval at 95%. Results: We included 982 eligible files out of 10328, giving an admission rate of 9.5%. 92 files were excluded, giving a final sample size of 890. 22.9% were newly diagnosed HIV positive with a female predominance (57.8%). The mean age was 44 ± 12 years and the median hospital stay was 7 days. The commonest causes of admission were tuberculosis (16.1%), pneumonia (13.4%), renal failure (13.1%), diarrheal diseases (11.3%) and meningoencephalitis (10.5%) with an in-hospital mortality rate of 26.1%. Absence of cotrimoxazole prophylaxis (aOR: 2.09, CI: 1.04 - 4.22, p = 0.038) was an independent risk factor for mortality, whereas WHO clinical stage 1 - 2 (aOR: 0.27, CI: 0.10 - 0.75, p = 0.012), absence of an associated diagnosis (aOR: 0.60, CI: 0.37-0.96, p = 0.036) and absence of previous admission (aOR: 0.55, CI: 0.30 - 0.98, p = 0.046) were found to be protective factors against mortality. WHO clinical stage 1 - 2 (aOR: 0.57, CI: 0.35 - 0.92, p = 0.023) and absence of an associated diagnosis (aOR: 0.52, CI: 0.37 - 0.73, p ≤ 0.001) were protective factors against prolonged hospital stay, whereas absence of comorbidities (aOR: 2.079, CI: 1.06 - 4.07, p = 0.033) was an independent a risk factor for prolonged hospital stay. Conclusion: Communicable diseases, including opportunistic infections, were the major causes of admission among PLWHIV at the BRH, and the in-hospital mortality was high. It shows that HIV remains a significant health problem in our setting. Therefore, as far as HIV is concerned, more efforts are needed to raise public awareness, improve early detection,
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