Causes and outcome of hospitalization among HIV-infected adults receiving antiretroviral therapy in Mulago hospital, Uganda

Abstract

Background: Cohorts describing cause specific mortality in HIV-infected patients initiating antiretroviral therapy (ART) operate on an outpatient basis. Hospitalized patients represent the spectrum and burden of severe morbidity and mortality in patients on ART. Objective: To determine the causes and outcomes of hospitalization among adults receiving ART. Methods: A prospective cohort study. We enrolled 201 participants (50% female) with median (IQR) age and CD4 count of 34 (28-40) years and 91(29-211) cells/uL respectively. Results: The most frequent causes of hospitalization were tuberculosis (TB) (37, 18%), cryptococcal meningitis (22, 11%), zidovudine (AZT) -associated anemia (19, 10%), sepsis (10, 5%) and Kaposi's sarcoma (10, 5%). Forty two patients (21%) died: 10 (24%) had TB, 8 (19%) had cryptococcal meningitis and 5 (12%) had sepsis, 9 (21%) had undiagnosed neurological syndromes while 10 (24%) had other illnesses. Predictors of death included low Karnofsky performance score of < 40 (OR, 21.1; CI 1.43-31.6) and age >34 years (OR, 7.65; CI 1.09-53.8).Conclusions: Opportunistic infections, malignancy and AZT-associated anemia contributed to most hospitalizations and mortality. It is important to intensify prevention, screening, and treatment for these opportunistic diseases and early ART initiation in HIV-infected patients. Tenofovir-based regimens, unless contraindicated should be scaled up to replace AZTbased regimens as first line ART drugs. Africa Health Sciences 2013; 13(4): 977 -985 http://dx

Mortality from HIV‐associated meningitis in sub‐Saharan Africa: a systematic review and meta‐analysis

“…In 10% (4/41) of included studies, the period of observation began prior to 2000. Seventeen countries were represented, with greatest representation from South Africa (14 studies) [34,[37][38][39][40][41][42][43][44][45][46][47][48][49], Ethiopia (three studies) [50][51][52] and Uganda (three studies) [53][54][55]; other countries had two or fewer studies [11,35,36,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74]. Amphotericin B-based induction therapy (with or without fluconazole) was the predominant induction regimen in 16 studies, fluconazole in 13 studies, and a mix of treatments (45% fluconazole and 43% amphotericin B) in one study [44], with antifungal regimens not specified in 11 studies.…”

Clinical profile and factors associated with mortality in hospitalized patients with HIV/AIDS: a retrospective analysis from Tripoli Medical Centre, Libya, 2013

“…By contrast, AIDS is still the main reason for hospitalization in developing countries, with various opportunistic infections playing major roles in HIVrelated morbidity and mortality (9)(10)(11). With such variations in the spectrum of HIV-related diseases, findings from developed countries might not be generalizable to our settings.…”

“…Late presentation is known to be associated with poor response to HAART (43), increased mortality (especially shortly after commencing HAART) (11,(40)(41)(42)(44)(45)(46), and high cumulative risk of HIV transmission (47).…”

Reasons for hospitalization of HIV-positive patients in Riga East clinical University hospital, Latvia, 2014

“…Hospitalization causes are studied in other countries as well, and such data varies in works of authors within a wide range, where as the main reasons are mentioned opportunistic infections (52%-46.5%), surgical treatment (10%), haematological disorders / tumors (8%), cardiovascular disorders (8%), neurological diseases (7%), gastrointestinal and liver abnormalities (6%) [29][30][31]. Using the Mann-Whitney U and Chi-square (χ2) tests, the author saw a close correlation (p<0.05) that HIV patients who are unemployed and who are co-infected with HCV are hospitalized more common (50%), most of these patients have an anamnestic IDU (58.9%), and 64.3% of these patients do not receive therapy.…”