Abstract
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. To determine the causes and outcomes of hospitalization among adults receiving ART. 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. 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). 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 AZT-based regimens as first line ART drugs.
Highlights
Infection with the human immune deficiency virus (HIV) has been a global pandemic and major cause of morbidity and mortality for over three decades
Majority (171, 85%) participants were classified as stage 3 or 4 using the World Health Organization (WHO) classification system, while 30 (15%) had stage 1 or 2 disease
These infections can be prevented if patients start antiretroviral therapy (ART) at CD4 counts above 500cell/ul, a departure from the 2010 WHO HIV treatment guidelines which recommend ART initiation at CD4 counts below 350cells/uL22
Summary
Infection with the human immune deficiency virus (HIV) has been a global pandemic and major cause of morbidity and mortality for over three decades. Significant effort has been put into scaling up antiretroviral therapy (ART) coverage worldwide; increasing coverage from 7% in 2003 to 37% in 2008 in subSaharan Africa. Cohorts describing cause specific mortality in HIV-infected patients initiating antiretroviral therapy (ART) operate on an outpatient basis. 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%). 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.
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