Original Research

Profile of presentation of HIV-positive patients to an emergency department in Johannesburg, South Africa

Abdullah E. Laher, Willem D.F. Venter, Guy A. Richards, Fathima Paruk
Southern African Journal of HIV Medicine | Vol 22, No 1 | a1177 | DOI: https://doi.org/10.4102/sajhivmed.v22i1.1177 | © 2021 Abdullah E. Laher, Willem D.F. Venter, Guy A. Richards, Fathima Paruk | This work is licensed under CC Attribution 4.0
Submitted: 11 October 2020 | Published: 29 January 2021

About the author(s)

Abdullah E. Laher, Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Willem D.F. Venter, Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Guy A. Richards, Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Fathima Paruk, Department of Critical Care, University of Pretoria, Pretoria, South Africa


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Abstract

Background: Despite improved availability and better access to antiretroviral therapy (ART), approximately 36% of human immunodeficiency virus (HIV)-positive South Africans are still not virally suppressed.

Objective: The aim of this study was to describe the patterns of presentation of HIV-positive patients to a major central hospital emergency department (ED).

Methods: In this prospectively designed study, consecutive HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) adult ED were enrolled between 07 July 2017 and 18 October 2018.

Results: A total of 1224 participants were enrolled. Human immunodeficiency virus was newly diagnosed in 212 (17.3%) patients, 761 (75.2%) were on ART, 245 (32.2%) reported ART non-adherence, 276 (22.5%) had bacterial pneumonia, 244 (19.9%) had tuberculosis (TB), 86 (7.0%) had gastroenteritis, 205 (16.7%) required intensive care unit admission, 381 (31.1%) were admitted for ≥ 7 days and 166 (13.6%) died. With regard to laboratory parameters, CD4 cell count was < 100 cell/mm3 in 527 (47.6%) patients, the viral load (VL) was > 1000 copies/mL in 619 (59.0%), haemoglobin was < 11 g/dL in 636 (56.3%), creatinine was > 120 µmol/L in 294 (29.3%), lactate was > 2 mmol/L in 470 (42.0%) and albumin was < 35 g/L in 633 (60.8%).

Conclusion: Human immunodeficiency virus-positive patients presenting to the CMJAH ED demonstrated a high prevalence of opportunistic infections, required a prolonged hospital stay and had high mortality rates. There is a need to improve the quality of ART services and accessibility to care.


Keywords

HIV; emergency department; ART non-adherence; CD4 cell count; HIV viral load; opportunistic infections; hospital admission; mortality

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Crossref Citations

1. Predictors of in‐hospital mortality among HIV‐positive patients presenting with an acute illness to the emergency department
AE Laher, F Paruk, WDF Venter, OA Ayeni, GA Richards
HIV Medicine  year: 2021  
doi: 10.1111/hiv.13097