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

• Published in: African health sciences Vol. 13; no. 4; pp. 977 - 985
• Main Authors: Namutebi, A.M.N, Kamya, M.R.K, Byakika-Kibwika, P
• Format: Journal Article
• Language: English
• Published: Uganda Makerere University Medical School 01-12-2013; Makerere Medical School
• Subjects: Adult; Adults; AIDS-Related Opportunistic Infections - epidemiology; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; CD4 Lymphocyte Count; Female; Health and Medicine; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - mortality; Hospitalization; Hospitalization - statistics & numerical data; Humans; Male; Meningitis, Cryptococcal - complications; Meningitis, Cryptococcal - diagnosis; Meningitis, Cryptococcal - mortality; Middle Aged; Original; Prospective Studies; Sepsis - complications; Sepsis - diagnosis; Sepsis - mortality; Treatment Outcome; Tuberculosis - complications; Tuberculosis - diagnosis; Tuberculosis - mortality; Uganda - epidemiology; Uganda
• ISSN: 1680-6905; 1729-0503; 1680-6905
• DOI: 10.4314/ahs.v13i4.17

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 AZT based regimens as first line ART drugs.