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

  • AMN Namutebi
  • MRK Kamya
  • P Byakika-Kibwika

Abstract

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 andm ortality. 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 AZTbased regimens as first line ART drugs.

Africa Health Sciences 2013; 13(4): 977 - 985

Author Biographies

AMN Namutebi
Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
MRK Kamya
Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
P Byakika-Kibwika
Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
Published
2014-01-30
Section
Articles

Journal Identifiers


eISSN: 1680-6905