Morbidity associated with HIV infection is poorly
characterised, so we aimed to investigate the contribution of different
comorbidities to hospital admission and in-hospital mortality in adults and
children living with HIV worldwide.
Using a broad search strategy combining terms for hospital
admission and HIV infection, we searched MEDLINE via PubMed, Embase, Web of
Science, LILACS, AIM, IMEMR and WPIMR from inception to Jan 31, 2015, to
identify studies reporting cause of hospital admission in people living with
HIV. We focused on data reported after 2007, the period in which access to
antiretroviral therapy started to become widespread. We estimated pooled proportions
of hospital admissions and deaths per disease category by use of random-effects
models. We stratified data by geographical region and age.
We obtained data from 106 cohorts, with reported causes of
hospital admission for 313 006 adults and 6182 children living with HIV.
- For
adults, AIDS-related illnesses (25 119 patients, 46%)
- and
bacterial infections (14 034 patients, 31%) were the leading causes of
hospital admission.
These two categories were the most common causes of
hospital admission for adults in all geographical regions and the most common
causes of mortality. Common region-specific
- in Africa
- causes of hospital admission
included
- malnutrition and wasting,
- parasitic infections, and
- haematological
disorders;
- in Europe
- respiratory disease,
- psychiatric disorders,
- renal disorders,
- cardiovascular disorders, and
- liver disease;
- in North America
- in South and Central America
- and respiratory,
- neurological,
- digestive and
- liver-related conditions,
- viral infections, and
- drug toxicity.
- For children,
- AIDS-related illnesses (783 patients,
27%) and
- bacterial infections (1190 patients, 41%, 26-56) were
the leading causes of hospital admission,
- followed by malnutrition and wasting,
- haematological disorders, and,
- in the African region, malaria.
Mortality in
individuals admitted to hospital was 20% (12,902 deaths) for
adults and 14% (10-19, 643 deaths) for children.
This review shows the importance of prompt HIV diagnosis and
treatment, and the need to reinforce existing recommendations to provide
chemoprophylaxis and vaccination against major preventable infectious diseases
to people living with HIV to reduce serious AIDS and non-AIDS morbidity.
By: Ford N1, Shubber Z2, Meintjes G3, Grinsztejn B4, Eholie S5, Mills EJ6, Davies MA7, Vitoria M8, Penazzato M8, Nsanzimana S9, Frigati L10, O'Brien D11, Ellman T12, Ajose O13, Calmy A14, Doherty M8.
- 1Department of HIV/AIDS, WHO, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa. Electronic address: fordn@who.int.
- 2Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
- 3Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
- 4Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Ministry of Health, Brazil.
- 5Unit of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Abidjan, Côte d'Ivoire.
- 6Global Evaluative Sciences, Vancouver, BC, Canada.
- 7Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa.
- 8Department of HIV/AIDS, WHO, Geneva, Switzerland.
- 9Rwanda Biomedical Center, Institute of HIV Disease Prevention and Control, Kigali, Rwanda; Swiss Tropical and Public Health Research Institute and Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel, Switzerland.
- 10Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, University of Stellenbosch, Cape Town, South Africa.
- 11Manson Unit, Médecins Sans Frontières, London, UK; Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.
- 12South Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa.
- 13Clinton Health Access Initiative, Boston, MA, USA.
- 14HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland.
