Omololu Ayanfe, Onukak Asukwo, Effiong Mfon, Oke Olaide, Isa Samson E, Habib Abdulrazaq G
Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria.
Department of Internal Medicine, University of Uyo, Uyo, Nigeria.
PLOS Glob Public Health. 2024 Jul 11;4(7):e0003487. doi: 10.1371/journal.pgph.0003487. eCollection 2024.
HIV infection continues to be a major public health issue, with significant morbidity and mortality especially in resource poor areas. Infection with HIV results in an increased risk of opportunistic infections and other complications, which may lead to hospital admission and death. Morbidity and mortality patterns among hospitalized persons living with HIV (PLHIV) have been well documented in high income countries, but there is paucity of such data in Nigeria. We investigated the reasons for hospitalization and predictors of death among adult PLHIV at the Federal Medical Center (FMC) Abeokuta, Nigeria. This was a hospital based cross-sectional study carried out over a 15-month period between January 2018 and March 2019. All consenting hospitalized adult PLHIV who met the inclusion criteria were enrolled into the study. Causes of hospitalization and death were obtained and analyzed. Over the study period, 193 hospitalizations of PLHIV were studied. Although a number of clinical syndromes were documented, Sepsis and Tuberculosis were the commonest causes of hospitalization and mortality. Mortality rate was 37(19.2%) for outcomes on day 30, with anaemia [OR 3.00 (95% C.I: 1.04-8.67)], poor adherence with Cotrimoxazole [OR 4.07 (95% C.I: 1.79-9.28)], poor adherence with cART [OR 13.40 (95% C.I: 3.92-45.44)], and a longer duration of fever [OR 3.34 (95% C.I: 1.10-9.99)] being predictors of mortality. Part of the study's limitation was resource-constraint of some of the indigent patient which affected their ability to access some diagnostic investigations and get optimal care thereby impacting on their outcome. Despite the upscaling of cART, opportunistic infections and sepsis remain common causes of hospitalization and death in adult PLHIV. More attention should therefore be placed on early diagnosis, prevention of immunosuppression and sepsis through timely administration and adherence to cART and other prophylactic measures.
艾滋病毒感染仍然是一个主要的公共卫生问题，尤其是在资源匮乏地区，其发病率和死亡率都很高。感染艾滋病毒会增加机会性感染和其他并发症的风险，这可能导致住院和死亡。在高收入国家，住院艾滋病毒感染者（PLHIV）的发病率和死亡率模式已有充分记录，但尼日利亚缺乏此类数据。我们调查了尼日利亚阿贝奥库塔联邦医疗中心成年PLHIV住院的原因及死亡预测因素。这是一项基于医院的横断面研究，在2018年1月至2019年3月的15个月期间进行。所有符合纳入标准且同意参与的住院成年PLHIV均纳入研究。获取并分析了住院和死亡原因。在研究期间，对193例PLHIV住院病例进行了研究。尽管记录了多种临床综合征，但脓毒症和结核病是住院和死亡的最常见原因。第30天的死亡率为37例（19.2%），贫血[比值比3.00（95%置信区间：1.04 - 8.67）]、复方新诺明依从性差[比值比4.07（95%置信区间：1.79 - 9.28）]、抗逆转录病毒治疗（cART）依从性差[比值比13.40（95%置信区间：3.92 - 45.44）]以及发热持续时间较长[比值比3.34（95%置信区间：1.10 - 9.99）]是死亡的预测因素。该研究的部分局限性在于一些贫困患者的资源限制，这影响了他们进行一些诊断检查和获得最佳治疗的能力，从而影响了他们的治疗结果。尽管扩大了cART的使用，但机会性感染和脓毒症仍然是成年PLHIV住院和死亡的常见原因。因此，应更加关注早期诊断，通过及时给药和坚持cART及其他预防措施来预防免疫抑制和脓毒症。
