Clinical, immunological, virological characteristics, and hospitalisation outcomes of patients admitted to Kiruddu Hospital with advanced HIV disease

Abstract

Introduction Nearly four decades after the first case of AIDS was described, the global number of AIDS related deaths is not declining as expected to meet elimination targets, especially in sub-Saharan Africa where the disease burden is greatest. Despite interventions to promote early HIV diagnosis and treatment, hospitalization related to advanced HIV disease (AHD) is still prevalent in public health facilities in Uganda. To assess the causes of hospitalization and hospitalization outcomes in the ‘test and treat’ era, we conducted a cross sectional study among in-patients with AHD, at Kiruddu National Referral Hospital. Methods In this cross-sectional study, clinical characteristics of HIV-positive adults with CD4<200 cells/L or WHO stage 3 or 4 clinical events were obtained through interviews; in-patient diagnosis and laboratory parameters through chart review, and hospitalization outcomes were evaluated prospectively. Descriptive data were summarized using percentages and medians as appropriate and logistic regression was used for multivariable analysis. Results Among hospitalized adults with AHD, 74% (260/353) knew their HIV status prior to hospitalization and 62% (219/353) were ART experienced at presentation. Overall, 73% had at least two etiological diagnoses and majority (non-mutually exclusive) were diagnosed with tuberculosis (61.2%;216/353), cryptococcal meningitis (20.7%), mucosal candidiasis (16.1%) and bacterial infections (15%). One in five (19%) participants died during hospitalization and in-hospital mortality was associated with age of 40 years or older [OR=2.53; 95%CI(1.22-5.24),P=0.01], altered mental status [OR=4.9; 95%CI(2.35-10.36), P<.001], hemoglobin <8 g/dl [OR=2.74; 95%CI (1.18-6.33), P=0.019], temperature above 37.5oC [OR=2.19; 95%CI (1.02-4.72), P=0.04] and CD4 <50 cells/L [OR=3.4; 95%CI(1.18-10.22), P=0.024] Conclusion Nearly two thirds of in-patients with advanced HIV disease were ART experienced and tuberculosis remains the most prevalent cause of hospitalization. Older adults and individuals hospitalized with altered mental status, elevated temperature, anemia, and profound immune suppression are at highest risk of in-hospital mortality. Novel strategies are needed to strengthen early HIV diagnosis in addition to retention in care after ART initiation.