College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia.
BMC Infect Dis. 2024 Jun 20;24(1):611. doi: 10.1186/s12879-024-09524-5.
Advanced HIV disease (AHD) in young people living with HIV (PLHIV) is an increasingly pressing public health issue in sub-Saharan Africa. Despite global progress in early HIV testing and reducing HIV-related deaths, many youths experience increased rates of HIV disease progression in sub-Saharan Africa. This study describes the burden, clinical manifestations, and factors for disease progression among young PLHIV aged 15 - 24 years seeking medical services at a major public hospital in Sierra Leone.
We performed a cross-sectional analysis of routinely collected data for PLHIV patients aged 15 to 24 seen at Connaught Hospital in Sierra Leone between September 2022 and March 2023. We estimated the proportion of AHD in young PLHIV and performed logistic regression modelling to explore predictors of AHD. The statistical significance level was set at 0.05 for all statistical tests.
Of the 581 PLHIV that were reported, 238 (40.9%) were between the ages of 15 and 24 years, with a median age of 22 (20-24), and 151 (63.5%) were females. On review, 178 (74.8%) has initiated antiretroviral therapy regimen (ART); 117 (65.7%) were actively on ART for ≤ 6 months, while 114 (64%) had interruptions with their ART treatment. The overall prevalence of AHD was 41.6% (99/238); 46.7% (35/68) of young PLHIV at the HIV clinic, and 39.3% (64/163) of admission. Sex-Female (OR, 0.51; 95% CI, 0.28-0.94; p = 0.030), and Tertiary Education level (OR, 0.27; 95% CI, 0.10 - 0.78; p = 0.015) have significantly lower odds of AHD in the entire study population. While for inpatients, Age (young Adults) of PLHIV (OR, 1.23; 95% CI, 1.00-1.52; p = 0.047) had 1.23 times the odds of AHD compared to adolescents, and being female (OR, 0.27; 95% CI, 0.08-0.84; p = 0.024), Overweight-Body mass index (OR, 0.10; 95% CI, 0.01-0.77; p = 0.028), Tertiary Education level (OR, 0.08; 95% CI, 0.01-0.52; p = 0.008) have significantly lower odds of AHD. Common conditions reported for the AHD group in the medical wards are tuberculosis (13.58%), hepatitis B (6.13%), Kaposi sarcoma (3.07%), and oesophagal candidiasis (2.45%).
We reported a high prevalence of advanced HIV among young patients in a tertiary Hospital in Sierra Leone. One in two young PLHIV aged 15 to 24 years reported AHD, emphasizing the need to strengthen public health measures that address access to and retention of HIV services.
在撒哈拉以南非洲，年轻人感染艾滋病毒（PLHIV）的晚期艾滋病（AHD）是一个日益紧迫的公共卫生问题。尽管在早期艾滋病毒检测和减少与艾滋病毒相关的死亡方面取得了全球进展，但许多年轻人在撒哈拉以南非洲经历了艾滋病毒疾病的发病率增加。本研究描述了在塞拉利昂一家主要公立医院寻求医疗服务的 15-24 岁年轻 PLHIV 的疾病负担、临床表现和疾病进展的因素。
我们对 2022 年 9 月至 2023 年 3 月期间在塞拉利昂康诺特医院就诊的 15 至 24 岁 PLHIV 患者的常规收集数据进行了横断面分析。我们估计了年轻 PLHIV 中 AHD 的比例，并进行了逻辑回归模型分析，以探讨 AHD 的预测因素。所有统计检验的统计显著性水平均设为 0.05。
报告的 581 名 PLHIV 中，238 名（40.9%）年龄在 15 至 24 岁之间，中位数年龄为 22（20-24），151 名（63.5%）为女性。经审查，178 名（74.8%）已开始抗逆转录病毒治疗方案（ART）；117 名（65.7%）在 ART 治疗期间的时间≤6 个月，而 114 名（64%）的 ART 治疗中断。AHD 的总患病率为 41.6%（99/238）；在 HIV 诊所的年轻 PLHIV 中，有 46.7%（35/68）患有 AHD，而在入院患者中，有 39.3%（64/163）患有 AHD。在整个研究人群中，女性（OR，0.51；95%CI，0.28-0.94；p=0.030）和高等教育水平（OR，0.27；95%CI，0.10-0.78；p=0.015）的 AHD 几率显著降低。而对于住院患者，PLHIV 的年龄（年轻人）（OR，1.23；95%CI，1.00-1.52；p=0.047）与青少年相比，AHD 的几率增加了 1.23 倍，而女性（OR，0.27；95%CI，0.08-0.84；p=0.024）、超重（体重指数）（OR，0.10；95%CI，0.01-0.77；p=0.028）、高等教育水平（OR，0.08；95%CI，0.01-0.52；p=0.008）的 AHD 几率显著降低。在医疗病房中，AHD 组报告的常见疾病包括肺结核（13.58%）、乙型肝炎（6.13%）、卡波西肉瘤（3.07%）和食管念珠菌病（2.45%）。
我们报告了塞拉利昂一家三级医院年轻患者中晚期艾滋病的高患病率。每两名 15 至 24 岁的年轻 PLHIV 中就有一人患有 AHD，这强调了需要加强公共卫生措施，以解决获得和维持艾滋病毒服务的问题。
