Cause of hospitalization and death in the antiretroviral era in Sub-Saharan Africa published 2008–2018

Abstract

Background: Worldwide despite the availability of antiretroviral therapy, human immunodeficiency virus/acquired immunodeficiency syndrome still causes morbidity and mortality among patients. In Sub-Saharan Africa, human immunodeficiency virus/ acquired immunodeficiency syndrome remains a major public health concern. The aim of this study was to identify the causes of morbidity and mortality in the modern antiretroviral therapy era in Sub-Saharan Africa.Methods: We conducted a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We searched relevant studies from 3 databases which are Google Scholar, PubMed, and CINAHL. Two review authors independently screened titles, abstracts, and full-text articles in duplicate, extracted data, and assessed bias. Discrepancies were resolved by discussion or arbitration of a third review author. R software version 3.6.2 was used to analyze the data. Maximum values were used in order to show which disease was mostly spread out by looking at the highest prevalence reported. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO).Results: A total of 409 articles were obtained from the database search, finally 12 articles met the inclusion criteria and were eligible for data extraction. Among them, 3 were conducted in Nigeria, 2 were conducted in Uganda, 3 were conducted in South Africa, 1 in Gabon, 1 in Ethiopia, 1 in Ghana, and 1 in Burkina Faso. In most of the included studies, tuberculosis was the leading cause of hospitalization which accounted for between 18% and 40.7% and it was also the leading cause of death and accounted for between 16% and 44.3%, except in 1 which reported anemia as the leading cause of hospitalization and in 2 which reported wasting syndrome and meningitis respectively as the leading causes of death. Opportunistic malignancies accounted between for 1.8% to 5% of hospitalization and 1.2% to 9.8% of deaths.Conclusions: Tuberculosis is the commonest cause of hospitalization and death in Sub-Saharan Africa, but it is always followed by other infectious disease and other non-AIDS related causes.Abbreviations: ART = antiretroviral therapy, CD4 = cluster of differentiation 4, HIV/AIDS = human immunodeficiency virus/ acquired immunodeficiency syndrome, Q2 = median, PICO = population, intervention, comparator and outcome, PLHIV = patients living with HIV, PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses, UKZN = University of KwaZulu-Natal.

Clinical characteristics and morbidity among hospitalized adults with advanced HIV disease in Uganda during ‘test and treat’ era

“…Our study suggests that tuberculosis accounts for most of the morbidity associated with advanced HIV disease among in-patients. This is consistent with what has been observed elsewhere in sub-Saharan Africa, however the prevalence of TB in our study was relatively higher than expected (61% versus 40%) [ 34 , 35 ]. This could be due to true increased prevalence related to health systems disruption by the COVID-19 pandemic or improved diagnostic capacity [ 36 ].…”

In-hospital Mortality and Causes of Death in People Diagnosed With HIV in a General Hospital in Shenyang, China: A Cross-Sectional Study

“…Our study, conducted in the general hospital of Northeast China, showed that AIDS-related illnesses remained the leading causes of hospital admission and in-hospital mortality, which was consistent with previous reports ( 4 , 5 ). PJP and TB remained the top two direct causes of admission and mortality in HIV-infected patients, which is consistent with previous findings ( 6 – 8 ).…”

“…Since June 15, 2016, the time to initiate ART has been updated based on CD4+T cell levels in China, as AIDS-related illnesses remain the leading causes of hospital admission and mortality worldwide ( 4 , 5 ). Risk factors for mortality should be surveyed in a timely manner and effectively addressed.…”

Neuroimmunology of CNS HIV Infection: A Narrative Review

“…Thus, many studies and clinical management decisions rely on syndromic clinical diagnoses with limited diagnostic precision, depending on the local resources. However, CNS opportunistic infections (OIs) are clearly common causes of hospitalization and may cause approximately 20% of deaths ( 14 , 15 ). For disorders such as HIV-associated dementia (HAD) and, by inference, also milder cognitive impairments, diagnostic precision is even more limited.…”

“…The spectrum of common CNS OIs is relatively circumscribed and involves organisms of relatively low pathogenicity that are otherwise readily contained or prevented by T-cell/macrophage defenses in the normal host. In Africa where M. tuberculosis is common in the community, HIV infection also enhances susceptibility even if this organism isn't readily classified as strictly “opportunistic” and is more common even at CD4 counts above those defining AIDS ( 15 ). However, the common CNS OIs generally occur at <200 CD4+ cells/μl ( 43 ).…”