Lethality among Patients with HIV/AIDS Monitored in the Clinic of Infectious Diseases in St George University Hospital, Plovdiv, 2010–2014

Abstract

Background: The introduction of complex antiretroviral therapy has resulted in signifi cant decrease in the mortality rate of HIV positive patients, but it still remains unacceptably high, especially in some groups of patients. Aim: To investigate the death rate in patients with HIV/AIDS, lethality and mortality in co-infection, and the most common causes and predictors of fatal outcome, focused on early diagnosis and appropriate therapy. Materials and methods: The study included 53 deceased patients with HIV/AIDS, monitored at the Clinic of Infectious Diseases in St George University Hospital, Plovdiv between 01.01.2010 and 31.12.2014. The methods of research included clinical analysis, laboratory tests, microbiological and serological tests (HCV, HBV, toxoplasmosis), ELISA, PCR. Statistical analysis was performed by descriptive statistics, the Student’s t-test, the method of Van der Ward, and regression analysis (logistic regression). Results: During the study period 316 patients with HIV/AIDS were monitored, 53 of them with lethal outcome. Lethality was 16.7% for the whole group; in intravenous drug users - 13.8%; in co-infected patients: HIV/M. tuberculosis - 46%, in HIV/HCV - 17.8%. Lethality and mortality in HIV(+) patients with co-infections in populations of diff erent age, gender, duration since starting сАRТ and degree of immunodefi ciency (according to CD4, VL) was compared with the lethality and mortality in patients with these conditions from the general population. Conclusions: Fatal outcome in patients with HIV/AIDS was most commonly associated with co-infections HIV/M. tuberculosis and HIV/HCV. Predictors of a fatal outcome are pulmonary tuberculosis, advanced immunodefi ciency with VL> 500 000 c/μL and CD4 <100/mm3, absence or non-systemic antiretroviral therapy.

Epidemiological differences and risk factors for hospitalization in people living with HIV in Istanbul, Turkey

“…Similar to our study, common coexistence of tuberculosis and AIDS was also reported in this study, and the fact that deaths were due to AIDS-related causes and importance of early ART use were emphasized. 14 Studies from other developing countries also report higher mortality rates among hospitalized PLHIV (up to 38% versus 2.6%). Mortality has been linked with advanced disease stages, low CD4 cell count, presence of opportunistic infections, and lack of resources for patient care.…”

“…Similar to our study, common coexistence of tuberculosis and AIDS was also reported in this study, and the fact that deaths were due to AIDS-related causes and importance of early ART use were emphasized. 14…”