Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium.
Medecins Sans Frontieres, Southern African Medical Unit, Cape Town, South Africa.
PLoS One. 2023 Mar 13;18(3):e0281425. doi: 10.1371/journal.pone.0281425. eCollection 2023.
Optimal management of critically ill HIV-positive patients during hospitalization and after discharge is not fully understood. This study describes patient characteristics and outcomes of critically ill HIV-positive patients hospitalized in Conakry, Guinea between August 2017 and April 2018 at discharge and 6 months post-discharge.
We carried out a retrospective observational cohort study using routine clinical data. Analytic statistics were used to describe characteristics and outcomes.
401 patients were hospitalized during the study period, 230 (57%) were female, median age was 36 (IQR: 28-45). At admission, 229 patients (57%) were on ART, median CD4 was 64 cells/mm3, 166 (41%) had a VL >1000 copies/ml, and 97 (24%) had interrupted treatment. 143 (36%) patients died during hospitalisation. Tuberculosis was the major cause of death for 102 (71%) patients. Of 194 patients that were followed after hospitalization a further 57 (29%) were lost-to-follow-up (LTFU) and 35 (18%) died, 31 (89%) of which had a TB diagnosis. Of all patients who survived a first hospitalisation, 194 (46%) were re-hospitalised at least once more. Amongst those LTFU, 34 (59%) occurred immediately after hospital discharge.
Outcomes for critically ill HIV-positive patients in our cohort were poor. We estimate that 1-in-3 patients remained alive and in care 6 months after their hospital admission. This study shows the burden of disease on a contemporary cohort of patients with advanced HIV in a low prevalence, resource limited setting and identifies multiple challenges in their care both during hospitalisation as well as during and after re-transitioning to ambulatory care.
目前对于危重症 HIV 阳性患者的住院和出院后管理尚不完全清楚。本研究描述了 2017 年 8 月至 2018 年 4 月期间在几内亚科纳克里住院的危重症 HIV 阳性患者的人口统计学特征和结局，包括出院时和出院后 6 个月时的情况。
我们开展了一项回顾性观察性队列研究，使用了常规临床数据。采用分析性统计方法来描述特征和结局。
在研究期间共收治了 401 例患者，其中 230 例（57%）为女性，中位年龄为 36 岁（IQR：28-45 岁）。入院时，229 例（57%）正在接受 ART 治疗，中位 CD4 为 64 个细胞/mm3，166 例（41%）病毒载量>1000 拷贝/ml，97 例（24%）中断了治疗。143 例（36%）患者在住院期间死亡。结核病是 102 例（71%）患者死亡的主要原因。在 194 例出院后接受随访的患者中，57 例（29%）失访（LTFU），35 例（18%）死亡，其中 31 例（89%）诊断为结核病。所有首次住院存活的患者中，194 例（46%）至少再次住院一次。在 LTFU 患者中，34 例（59%）发生在出院后立即。
我们队列中危重症 HIV 阳性患者的结局较差。我们估计，在医院入院后 6 个月时，有 1/3 的患者仍然存活并接受治疗。本研究在低流行、资源有限的环境中，对一组晚期 HIV 患者的疾病负担进行了描述，并确定了他们在住院期间以及在过渡到门诊护理期间和之后的护理中面临的多个挑战。
