Burke Rachael M, Sabet Nadia, Ellis Jayne, Rangaraj Ajay, Lawrence David S, Jarvis Joseph N, Falconer Jane, Tugume Lillian, Bidwell Gabriella, Berhanu Rebecca H, MacPherson Peter, Ford Nathan
Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK; Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi.
University of the Witwatersrand, Johannesburg, South Africa.
Lancet HIV. 2025 May;12(5):e355-e366. doi: 10.1016/S2352-3018(24)00347-3. Epub 2025 Mar 26.
Despite improved access to antiretroviral therapy (ART), HIV-related morbidity and mortality remain high. A previous review (2007-14) found that AIDS-related illnesses were the leading causes of hospitalisations. We aimed to summarise the causes of hospitalisations among people living with HIV from 2014 to 2023.
For this meta-analysis we searched eight databases (Ovid Medline ALL, Ovid Embase Classic and Ovid Embase, Ovid Global Health, EBSCOhost CINAHL Complete, EBSCOhost Africa-Wide Information, Clarivate Analytics Web of Science Core Content, Clarivate Analytics Web of Science SciELO, and Global Index Medicus) on April 26, 2023. We included studies of any design that reported on the cause of admission to hospital for at least 20 people after Jan 1, 2014. We extracted summary-level data about CD4 cell counts, ART use, cause of admission, and incidence of death, and assessed risk of bias with the use of a modified Newcastle-Ottowa Scale. We constructed random effects models to estimate prevalence of various diseases as a cause of hospital admission.
From the 19 629 records identified, we obtained data from 110 studies representing 100 628 hospital admissions. The weighted median CD4 count was 111 cells per μL (range of medians 25-713); 60% of admissions (95% Cl 54-66) were people receiving ART. The most common cause of admission was AIDS-related illnesses (42% of admissions, 95% CI 35-49), including tuberculosis (19%, 15-23). The second most common cause was bacterial infection (26%, 20-33). AIDS-related illnesses were more common in WHO regions of South and Central America (62%, 53-71), Africa (49%, 39-60), Western Pacific (68%, 57-77), and South-East Asia (40%, 31-50) than in Europe (30%, 23-37) and North America (13%, 6-25). Wasting and parasitic infections were more common in children (malnutrition 31%, 11-63; parasitic infection 13%, 4-37) than in adults. In-hospital mortality was 17% (13-20), with substantial regional variation.
Our results indicate providing high-quality care to hospitalised people with HIV-related conditions (AIDS-related illness and severe bacterial infections) should be prioritised.
The Bill & Melinda Gates Foundation.
尽管获得抗逆转录病毒疗法（ART）的机会有所改善，但与艾滋病病毒相关的发病率和死亡率仍然很高。先前的一项综述（2007 - 2014年）发现，艾滋病相关疾病是住院的主要原因。我们旨在总结2014年至2023年期间艾滋病病毒感染者的住院原因。
对于这项荟萃分析，我们于2023年4月26日检索了八个数据库（Ovid Medline ALL、Ovid Embase Classic和Ovid Embase、Ovid Global Health、EBSCOhost CINAHL Complete、EBSCOhost Africa - Wide Information、Clarivate Analytics Web of Science Core Content、Clarivate Analytics Web of Science SciELO和Global Index Medicus）。我们纳入了任何设计的研究，这些研究报告了2014年1月1日之后至少20人的住院原因。我们提取了关于CD4细胞计数、抗逆转录病毒疗法使用情况、住院原因和死亡发生率的汇总数据，并使用改良的纽卡斯尔 - 渥太华量表评估偏倚风险。我们构建随机效应模型来估计各种疾病作为住院原因的患病率。
从识别出的19629条记录中，我们从110项研究中获得了数据，代表100628例住院病例。加权中位数CD4细胞计数为每微升111个细胞（中位数范围为25 - 713）；60%的住院患者（95%CI 54 - 66）正在接受抗逆转录病毒疗法。最常见的住院原因是艾滋病相关疾病（42%的住院病例，95%CI 35 - 49），包括结核病（19%，15 - 23）。第二常见的原因是细菌感染（26%，20 - 33）。艾滋病相关疾病在世界卫生组织的南美洲和中美洲地区（62%，53 - 71）、非洲（49%，39 - 60）、西太平洋地区（68%，57 - 77）和东南亚地区（40%，31 - 50）比在欧洲（30%，23 - 37）和北美洲（13%，6 - 25）更常见。消瘦和寄生虫感染在儿童中比在成人中更常见（营养不良31%，11 - 63；寄生虫感染13%，4 - 37）。住院死亡率为17%（13 - 20），存在显著的地区差异。
我们的结果表明，应优先为患有与艾滋病病毒相关疾病（艾滋病相关疾病和严重细菌感染）的住院患者提供高质量护理。
比尔及梅琳达·盖茨基金会。
