Mortality and associated factors among people living with HIV admitted at a tertiary-care hospital in Uganda: a cross-sectional study

• Published in: BMC infectious diseases Vol. 24; no. 1; pp. 239 - 10
• Main Authors: Owachi, Darius, Akatukunda, Praise, Nanyanzi, Diana Sarah, Katwesigye, Rogers, Wanyina, Shardrack, Muddu, Martin, Kawuma, Samuel, Kalema, Nelson, Kabugo, Charles, Semitala, Fred C.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 22.02.2024; BioMed Central Ltd; BMC
• Subjects: Acquired immune deficiency syndrome; Advanced HIV disease; AIDS; Analysis; Anemia; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Cardiovascular disease; Care and treatment; CD4 antigen; Confidence intervals; Counseling; COVID-19; Cross-sectional studies; Diabetes; Diagnosis; Emergency medical care; Health aspects; Highly active antiretroviral therapy; HIV; HIV (Viruses); HIV infection; HIV patients; Hospitalization; Hospitals; Human immunodeficiency virus; Infections; Infectious Diseases; Inpatient; Internal Medicine; Kaposis sarcoma; Kidney diseases; Liver; Liver diseases; Lung diseases; Malnutrition; Medical Microbiology; Medicine; Medicine & Public Health; Mortality; Multivariate analysis; Nervous system diseases; Neurological diseases; Parasitology; Patient outcomes; Patients; Population; Public health; Regression analysis; Risk factors; Statistical analysis; Tropical Medicine; Uganda; Uganda; Sub-Saharan Africa; Inpatient; Advanced HIV disease; Uganda; Hospitalization; Mortality
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-024-09112-7

Background Hospital admission outcomes for people living with HIV (PLHIV) in resource-limited settings are understudied. We describe in-hospital mortality and associated clinical-demographic factors among PLHIV admitted at a tertiary-level public hospital in Uganda. Methods We performed a cross-sectional analysis of routinely collected data for PLHIV admitted at Kiruddu National Referral Hospital between March 2020 and March 2023. We estimated the proportion of PLHIV who had died during hospitalization and performed logistic regression modelling to identify predictors of mortality. Results Of the 5,827 hospitalized PLHIV, the median age was 39 years (interquartile range [IQR] 31–49) and 3,293 (56.51%) were female. The median CD4 + cell count was 109 cells/µL (IQR 25–343). At admission, 3,710 (63.67%) were active on antiretroviral therapy (ART); 1,144 (19.63%) had interrupted ART > 3 months and 973 (16.70%) were ART naïve. In-hospital mortality was 26% (1,524) with a median time-to-death of 3 days (IQR 1–7). Factors associated with mortality (with adjusted odds ratios) included ART interruption, 1.33, 95% confidence intervals (CI) 1.13–1.57, p 0.001; CD4 + counts ≤ 200 cells/µL 1.59, 95%CI 1.33–1.91, p  < 0.001; undocumented CD4 + cell count status 2.08, 95%CI 1.73–2.50, p  < 0.001; impaired function status 7.35, 95%CI 6.42–8.41, p  < 0.001; COVID-19 1.70, 95%CI 1.22–2.37, p 0.002; liver disease 1.77, 95%CI 1.36–2.30, p  < 0.001; co-infections 1.53, 95%CI 1.32–1.78, p  < 0.001; home address > 20 km from hospital 1.23, 95%CI 1.04–1.46, p 0.014; hospital readmission 0.7, 95%CI 0.56–0.88, p 0.002; chronic lung disease 0.62, 95%CI 0.41–0.92, p 0.019; and neurologic disease 0.46, 95%CI 0.32–0.68, p  < 0.001. Conclusion One in four admitted PLHIV die during hospitalization. Identification of risk factors (such as ART interruption, function impairment, low/undocumented CD4 + cell count), early diagnosis and treatment of co-infections and liver disease could improve outcomes.