Laher Abdullah E, Venter Willem D F, Richards Guy A, Paruk Fathima
Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
South Afr J HIV Med. 2021 Jan 29;22(1):1177. doi: 10.4102/sajhivmed.v22i1.1177. eCollection 2021.
Despite improved availability and better access to antiretroviral therapy (ART), approximately 36% of human immunodeficiency virus (HIV)-positive South Africans are still not virally suppressed.
The aim of this study was to describe the patterns of presentation of HIV-positive patients to a major central hospital emergency department (ED).
In this prospectively designed study, consecutive HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) adult ED were enrolled between 07 July 2017 and 18 October 2018.
A total of 1224 participants were enrolled. Human immunodeficiency virus was newly diagnosed in 212 (17.3%) patients, 761 (75.2%) were on ART, 245 (32.2%) reported ART non-adherence, 276 (22.5%) had bacterial pneumonia, 244 (19.9%) had tuberculosis (TB), 86 (7.0%) had gastroenteritis, 205 (16.7%) required intensive care unit admission, 381 (31.1%) were admitted for ≥ 7 days and 166 (13.6%) died. With regard to laboratory parameters, CD cell count was < 100 cell/mm in 527 (47.6%) patients, the viral load (VL) was > 1000 copies/mL in 619 (59.0%), haemoglobin was < 11 g/dL in 636 (56.3%), creatinine was > 120 µmol/L in 294 (29.3%), lactate was > 2 mmol/L in 470 (42.0%) and albumin was < 35 g/L in 633 (60.8%).
Human immunodeficiency virus-positive patients presenting to the CMJAH ED demonstrated a high prevalence of opportunistic infections, required a prolonged hospital stay and had high mortality rates. There is a need to improve the quality of ART services and accessibility to care.
尽管抗逆转录病毒疗法（ART）的可及性有所提高且更容易获得，但约36%的南非人类免疫缺陷病毒（HIV）阳性患者仍未实现病毒学抑制。
本研究的目的是描述HIV阳性患者前往一家大型中心医院急诊科（ED）的就诊模式。
在这项前瞻性设计的研究中，2017年7月7日至2018年10月18日期间，连续纳入前往夏洛特·马克塞克约翰内斯堡学术医院（CMJAH）成人急诊科就诊的HIV阳性患者。
共纳入1224名参与者。212名（17.3%）患者为新诊断的HIV感染，761名（75.2%）正在接受ART治疗，245名（32.2%）报告未坚持ART治疗，276名（22.5%）患有细菌性肺炎，244名（19.9%）患有结核病（TB），86名（7.0%）患有肠胃炎，205名（16.7%）需要入住重症监护病房，381名（31.1%）住院≥7天，166名（13.6%）死亡。关于实验室参数，527名（47.6%）患者的CD细胞计数<100个细胞/mm³，619名（59.0%）患者的病毒载量（VL）>1000拷贝/mL，636名（56.3%）患者的血红蛋白<11 g/dL，294名（29.3%）患者的肌酐>120 µmol/L，470名（42.0%）患者的乳酸>2 mmol/L，633名（60.8%）患者的白蛋白<35 g/L。
前往CMJAH急诊科就诊的HIV阳性患者机会性感染患病率高，住院时间长，死亡率高。需要提高ART服务质量和医疗可及性。
