Mortality in Hospitalised HIV/AIDS Patients in a Tertiary Centre in Sub-Saharan Africa: Trends Between 2007 and 2015, Causes and Associated Factors

Abstract

Background: With easy accessibility to combination Antiretroviral Therapy (cART), mortality amongst hospitalized HIV/AIDS patients needs to be described. Objective: We aimed at determining the trends, causes and factors associated with in-hospital mortality amongst HIV/AIDS patients in the Douala General Hospital. Methods: We retrospectively reviewed hospitalisation records of HIV/AIDS patients hospitalized in the medical wards of the DGH from 2007 to 2015. Four cause-of-death categories were defined: 1. Communicable conditions and AIDS-defining malignancies, 2. Chronic non-communicable conditions and non-AIDS defining malignancies’, 3. Other non-communicable conditions and 4. Unknown conditions. Logistic regression was used to determine factors associated mortality. Results: We analyzed 891 eligible files. The mean age was 43 (standard deviation (SD): 10) years and median length of hospital stay was 9 (interquatile range (IQR)4 - 15) days. The overall all-cause mortality was 23.5% (95% CI: 20.8% - 26.4%). The category - communicable conditions and AIDS defining malignancies represented 79.9%, of deaths and this remained constant for each year during the study period. Tuberculosis was the most common specific cause of death (23.9%). Patients who had two (OR=2.35, 95%CI: 1.35 - 4.06) and more than two (OR=4.23, 95%CI: 1.62 – 11.12) opportunistic infections, a haemoglobin level less than 10g/l (OR=2.38, 95%CI: 1.58 - 3.59) had increased odds of dying. Conclusion: In-hospital mortality is high amongst HIV/AIDS patients at the Douala general hospital. The category - communicable conditions and AIDS defining malignancies - is still the main underlying cause of death. We hope that our findings will help to develop interventions aimed at reducing in-hospital mortality.

Survival Status and Its Predictors Among Adult Human Immunodeficiency Virus Infected Patients Attending Their Antiretroviral Treatment at Health Centers in Kirkos Sub City, Addis Ababa, Ethiopia. A Retrospective Cohort Study

“…This study found that patients whose CD4 cell count < 200cells/ mm3 had a higher risk of death compared to patients with a CD4 cell count ≥ 500cells/mm3. The study showed that the CD4 cell count was an independent predictor of AIDS progression, and was also consistent with the other research results done outside of Ethiopia [21], [22] which indicated that AIDS progression to death was clustered among patients starting therapy with a lower CD4 cell count. Thus, emphasizing the need to early diagnose, link, and engage patient into the comprehensive ART care program.…”

Mortality and Its Predictors among Adult Human Immune-Deficiency Virus-Infected Patients Attending Their Antiretroviral Treatment at Health Centers, Addis Ababa, Ethiopia: Multicenter Retrospective Cohort Study

“…We demonstrated that patients whose CD4 cell count was <200 cells/mm3 had a higher risk of death compared to patients with a CD4 cell count ≥ of 500 cells/mm3. The study showed that the CD4 cell count was an independent predictor of AIDS progression, and it is a consistent finding with other research results conducted outside of Ethiopia [ 9 , 23 ] which indicated that AIDS progression to death was clustered among patients starting therapy with a lower CD4 cell count. Thus, emphasizing the need for early diagnosis, linking, and engaging patients in a comprehensive ART care program could help reduce mortality rates.…”

“…A viral load greater than 400 copies/mL, a CD4 count less than 200 cells/mL, TB coinfection, opportunistic infections, ART regimen, drug allergy, and low hemoglobin levels are predictors of mortality [6,7]. However, these are not the only factors that lead to HIV/AIDS mortality [8][9][10][11].…”