Research Article: Morbidity and Mortality Patterns of Hospitalised Adult HIV/AIDS Patients in the Era of Highly Active Antiretroviral Therapy: A 4-year Retrospective Review from Zaria, Northern Nigeria

Date Published: September 17, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Dimie Ogoina, Reginald O. Obiako, Haruna M. Muktar, Mukhtar Adeiza, Aliyu Babadoko, Abdulaziz Hassan, Isa Bansi, Henry Iheonye, Matthew Iyanda, Eric Tabi-Ajayi.


Background. This study, undertaken in major tertiary hospital in northern Nigeria, examined the morbidity and mortality patterns of hospitalised adult HIV/AIDS patients in the HAART era.
Methods. Between January 2006 and December 2009, admission records and causes of deaths of hospitalised medical HIV-infected patients were retrieved and analysed according to antiretroviral (ART) status. Results. Of the 207 HIV/AIDS patients reviewed, majority were newly diagnosed (73.4%), and most were hospitalised and died from various AIDS-defining illnesses, mainly disseminated tuberculosis and sepsis. Immune-inflammatory-reconstitution-syndrome, ART-toxicity and ART-failure, contributed to morbidity and mortality in patients receiving ART. Sixty six (31.9%) patients died, with higher mortality in males and in those with lower CD4-cell count, lower PCV, and shorter hospital stay. However, hospital stay ≤3 days and severe anaemia (PCV < 24%) were independent predictors of mortality. Conclusion. In the current HAART era, late presentation and tuberculosis continue to fuel the HIV/AIDS pandemic in Africa, with emerging challenges due to ART-related complications.

Partial Text

Nigeria is among the top ranked countries with high human immunodeficiency virus (HIV) burden worldwide, with about 3.1 million HIV-infected people and an estimated 215,000 HIV-related deaths in 2010 [1]. Many studies from Nigeria have described the critical role of HIV/acquired immunodeficiency syndrome (AIDS) as a cause of morbidity and mortality in both hospitalised and clinic-based adult patients [2–7].

The results of this study has shown that in the current era of HAART in Nigeria, majority of the hospitalised HIV-infected patients are heterosexuals of young productive age and that most of the newly diagnosed HIV-infected patients as well as patients receiving ART are hospitalised on account of AIDS-defining illnesses characterised by severe immunosuppression and anaemia. These findings possibly reflect late HIV diagnosis and delay in initiation of HAART. It is worrisome that even with the provision of free ARV drugs in many parts of Sub-Saharan African many HIV/AIDS patients from this region still suffer from advanced HIV-related diseases [16], whereas in the developed world, morbidity is mainly due to HIV-unrelated diseases [17, 18]. To facilitate early HIV diagnosis and early initiation of HAART, all stakeholders in the region must make concerted effort to expand and implement voluntary counselling and testing as well as the provider-initiated testing and counselling, even as new strategies are developed to detect early infection for prompt initiation of HAART, when necessary.

This study undertaken in a major tertiary hospital in Northern Nigeria during the HAART era has shown that majority of hospitalised HIV/AIDS patients are heterosexuals of young productive age, males and newly diagnosed HIV-infected patients with no previous ART experience. Most patients were admitted on account of AIDS defining illness such as disseminated TB and sepsis, with features of severe immunosuppression and anaemia. The study data also revealed that mortality was high due to late presentation and advanced disease, and that there was a six-fold risk of mortality in those with severe anaemia. To combat the high morbidity and mortality associated with HIV/AIDS in developing countries such as Nigeria, strategies for early HIV diagnosis, prompt initiation of HAART, prevention of TB co-infection in HIV, and early recognition of danger signs such as low PCV must be initiated, implemented, and strengthened as necessary.




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