Abstract
BackgroundIn the era of increased access to HIV testing and antiretroviral treatment (ART), the impact of HIV and ART status on inpatient mortality in Malawi is unknown.MethodsWe prospectively followed adult inpatients at Kamuzu Central Hospital medical wards in Lilongwe, Malawi, between 2011 and 2012, to evaluate causes of mortality, and the impact of HIV and ART status on mortality. We divided the study population into five categories: HIV-negative, new HIV-positive, ART-naïve patients, new ART-initiators, and ART-experienced. We used multivariate binomial regression models to compare risk of death between categories.ResultsAmong 2911 admitted patients the mean age was 38.5 years, and 50% were women. Eighty-one percent (81%) of patients had a known HIV status at the time of discharge or death. Mortality was 19.4% and varied between 13.9% (HIV-negative patients) and 32.9% (HIV-positive patients on ART ≤1 year). In multivariable analyses adjusted for age, sex and leading causes of mortality, being new HIV-positive (RR = 1.64 95% CI: 1.16–2.32), ART-naive (RR = 2.28 95% CI: 1.66–2.32) or being a new ART-initiator (RR = 2.41 95% CI: 1.85–3.14) were associated with elevated risk of mortality compared to HIV-negative patients. ART-experienced patients had comparable mortality (RR = 1.33 95% CI: 0.94–1.88) to HIV-negative patients.ConclusionHIV related mortality remains high among medical inpatients, especially among HIV-positive patients who recently initiated ART or have not started ART yet.
Highlights
Marked and sustained reductions in opportunistic disease and AIDS-related death have been observed world-wide as a consequence of increased access to HIV testing and extensive use of antiretroviral therapy (ART) [1,2,3,4]
In multivariable analyses adjusted for age, sex and leading causes of mortality, being new HIV-positive (RR = 1.64 95% CI: 1.16–2.32), ARTnaive (RR = 2.28 95% CI: 1.66–2.32) or being a new antiretroviral treatment (ART)-initiator (RR = 2.41 95% CI: 1.85– 3.14) were associated with elevated risk of mortality compared to HIV-negative patients
ART-experienced patients had comparable mortality (RR = 1.33 95% CI: 0.94–1.88) to HIVnegative patients
Summary
Marked and sustained reductions in opportunistic disease and AIDS-related death have been observed world-wide as a consequence of increased access to HIV testing and extensive use of antiretroviral therapy (ART) [1,2,3,4]. These health benefits have been observed across diverse patient populations, leading to reduced hospitalization and mortality from HIV/AIDS related illnesses [5,6,7,8,9] and increased life expectancy [10]. Increased case-finding allows patients to access HIV care which includes early diagnosis and treatment of opportunistic infections and early ART initiation These treatments are known to reduce mortality from AIDS-related illnesses and transmission to uninfected partners [14]. In the era of increased access to HIV testing and antiretroviral treatment (ART), the impact of HIV and ART status on inpatient mortality in Malawi is unknown
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