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Original Research
Effect of HIV on mortality among hospitalised patients in South Africa
Submitted: 08 January 2023 | Published: 26 April 2023
About the author(s)
Dirk J. Lamprecht, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaNeil Martinson, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; and, Johns Hopkins University Center for TB Research, Johns Hopkins University, Baltimore, United States of America
Ebrahim Variava, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Internal Medicine, Klerksdorp/Tshepong Hospital Complex, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Abstract
Background: HIV and AIDS continues to impose substantial healthcare challenges in sub-Saharan Africa, but there are limited local data comparing inpatient outcomes between people with HIV (PLWH) and those uninfected.
Objectives: To compare cause-specific mortality among hospitalised adolescents and adults, stratified by HIV-serostatus.
Method: A cross-sectional analysis was performed, analysing cause-specific inpatient mortality data and total admissions, from 01 January 2017 to 30 June 2020, at Tshepong Hospital, North West province, South Africa.
Results: The overall inpatient mortality rate decreased from 14.5% (95% confidence interval [CI]: 13.4–16.0) in 2017, to 11.3% (95% CI: 10.6–11.9) in 2020; P < 0.001. People living with HIV accounted for 53.9% (n = 2342) of inpatient deaths, 22.6% (n = 984) were HIV-seronegative patients and 23.5% (n = 1020) patients with unknown HIV-serostatus. People with HIV died at younger ages (median: 44 years, interquartile range [IQR]: 35.8–54.2) compared to HIV-seronegative inpatients (median: 64.4 years, IQR: 55.5–73.9); P < 0.001. Leading causes of death were pneumonia (19.9%, n = 863), then pulmonary and extrapulmonary tuberculosis (15.0%, n = 654). People with HIV who had CD4+ counts < 350 cells/mL or viral load ≥ 1000 copies/mL had increased risk of death from tuberculosis compared to virally suppressed patients (adjusted relative risk: 2.10 [95% CI: 1.44–3.04, P < 0.009] and 1.56 [95% CI: 1.22–2.00, P < 0.001]).
Conclusion: Our study, conducted in a regional hospital in South Africa, showed PLWH had higher mortality rates and died at younger ages compared to HIV-seronegative patients.
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