Abstract
BackgroundHIV infection is a growing public health problem in Sierra Leone and the wider West Africa region. The countrywide HIV prevalence was estimated at 1.7% (67,000 people), with less than 30% receiving life-saving ART in 2016. Thus, HIV-infected patients tend to present to health facilities late, with high mortality risk.MethodsWe conducted a prospective study of HIV inpatients aged ≥15 years at Connaught Hospital in Freetown—the main referral hospital in Sierra Leone—from July through September 2017, to assess associated factors and predictors of HIV-related mortality.ResultsOne hundred seventy-three HIV inpatients were included, accounting for 14.2% (173/1221) of all hospital admissions during the study period. The majority were female (59.5%, 70/173), median age was 34 years, with 51.4% (89/173) of them diagnosed with HIV infection for the first time during the current hospitalization. The most common admitting diagnoses were anemia (48%, 84/173), tuberculosis (24.3%, 42/173), pneumonia (17.3%, 30/173) and diarrheal illness (15.0%, 26/173). CD4 count was obtained in 64.7% (112/173) of patients, with median value of 87 cells/μL (IQR 25–266), and was further staged as severe immunosuppression: CD4 < 100 cells/μL (50%, 56/112); AIDS: CD4 < 200 cells/μL (69.6%, 78/112); and late-stage HIV disease: CD4 < 350 cells/μL (83%, 93/112). Fifty-two patients (30.1%, 52/173) died during hospitalization, 23% (12/52) of them within the first week. The leading causes of death were anemia (23.1%, 12/52), pneumonia (19.2%, 10/52), diarrheal illness (15.4%, 8/52) and tuberculosis (13.6%, 7/52). Neurological symptoms, i.e., loss of consciousness (p = 0.04) and focal limb weakness (p = 0.04); alcohol use (p = 0.01); jaundice (p = 0.02); cerebral toxoplasmosis (p = 0.01); and tuberculosis (p = 0.04) were significantly associated with mortality; however, only jaundice (AOR 0.11, 95% CI [0.02–0.65]; p = 0.01) emerged as an independent predictor of mortality.ConclusionHIV-infected patients account for a substantial proportion of admissions at Connaught Hospital, with a high morbidity and in-hospital mortality burden. These findings necessitate the implementation of specific measures to enhance early HIV diagnosis and expand treatment access to all HIV-infected patients in Sierra Leone.
Highlights
human immunodeficiency virus (HIV) infection is a growing public health problem in Sierra Leone and the wider West Africa region
HIV-infected patients account for a substantial proportion of admissions at Connaught Hospital, with a high morbidity and in-hospital mortality burden. These findings necessitate the implementation of specific measures to enhance early HIV diagnosis and expand treatment access to all HIV-infected patients in Sierra Leone
Despite the global roll-out of antiretroviral therapy (ART), high in-hospital mortality associated with human immunodeficiency virus (HIV) infection remains a major problem in HIV care in resource-limited settings
Summary
HIV infection is a growing public health problem in Sierra Leone and the wider West Africa region. Despite the global roll-out of antiretroviral therapy (ART), high in-hospital mortality associated with human immunodeficiency virus (HIV) infection remains a major problem in HIV care in resource-limited settings. The proportion of deaths reported from the World Health Organization (WHO) region of West and Central Africa was striking. Countries in this WHO region have consistently reported low HIV seroprevalence rates for many years (generally < 4%) [2], West and Central Africa accounted for 30% (280, 000) of the global mortality in 2017 [1], highlighting a regional public health problem of growing magnitude and importance. This study recorded an in-hospital mortality rate of 38% [5]; given that it was conducted almost a decade ago before HIV services were scaled-up, the findings may not be reflective of current trends—the need for an update from countries in the region
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