Clinical Profiles of HIV-Infected, HAART-Naive Patients Admitted to a Tertiary Level Hospital in Maseru, Lesotho

摘要

Introduction: Southern Africa has one of the highest HIV prevalence rates globally. The HIV epidemic in the region is characterised by high rates of morbidity and mortality. The aim of this study was to document the clinical profiles of patients hospitalised for the treatment of HIV-related disorders in Maseru, Lesotho. Methods: A prospective observational study of 105 HIV-infected, HAART-na?ve patients admitted at Queen Elizabeth II Referral Hospital in Maseru.Results: The median age was 34 years and 50.5% were female. 74 patients (70.5%) had tested positive for HIV before admission. 85.9% of all patients had presented with Stage III or IV events at diagnosis of HIV infection. 69.5% of the patients were treated for opportunistic infections of which tuberculosis was the commonest (n = 43, 41.0%) followed by oral candidiasis (n = 19, 18.1%) and pneumonia (n = 11, 10.5%). 35 patients (33.3%) had severe anaemia (Hb < 8g/dl). The median CD4 count was 73.5 cells/μl; 62 patients (59.0%) were in Stage III and 43 (41.0%) were in Stage IV of HIV infection. The median duration of hospitalisation was 9 days; prolonged hospitalisation was associated with extrapulmonary tuberculosis and cryptococcal meningitis. The in-hospital mortality was 30.5%; the mortality rate was higher among patients with advanced AIDS (Stage IV).Conclusions: The majority of the patients presented with HIV-related opportunistic infections. The main factors contributing to morbidity and mortality in this study were late presentation for diagnosis of HIV infection and treatment of HIV-related disorders. Introduction Southern Africa has one of the highest HIV prevalence rates globally. Lesotho is among the worst affected countries by HIV/AIDS in the region. At the end of 2004, the national HIV prevalence for persons aged 15 to 49 years was estimated at 23.2% [1]. Most people living with HIV/AIDS are women (56% of the adults); and prevalence rates of more than 80% have been reported among people with tuberculosis [1, 2]. It is well established that early initiation of anti-retroviral therapy (ART) can reduce both morbidity and mortality in HIV-infected patients [3-5]. Since 2004, efforts have been made to scale up ART delivery to all HIV-infected persons who qualify for ART in Lesotho. In spite of these measures, the HIV epidemic in Lesotho is still characterised by a high case-fatality ratio. In 2007/8, HIV/AIDS accounted for 10% and 12% of all adult male and female admissions to public sector hospitals in Lesotho and, over the same period, for 26% and 31% of male and female institutional deaths respectively [6]. The clinical features of HIV-infected patients at HIV diagnosis in Lesotho and the factors associated with hospitalisation in HIV-infected persons have not been studied. The aim of this study was to report the clinical and laboratory profiles of HIV-infected, ART-naive patients hospitalised for the management of HIV-related disorders in Maseru, Lesotho. Methods A prospective observational study was conducted at Queen Elizabeth II (QE II) Referral Hospital in Maseru, Lesotho. QEII Hospital is a public sector tertiary level hospital; it is also the national referral hospital. The study population included consecutive 105 adult patients (> 15 years) admitted to the male and female wards between July and October 2010. Patients were included if they were HIV seropositive (either known to be seropositive prior to admission or tested positive following admission), not receiving highly active anti-retroviral therapy (HAART) and admitted for the treatment of HIV-related disorders. All patients gave informed consent for taking part in the study. Patient demographic information, medical history including diagnosis of HIV-infection, diagnosis and treatment of opportunistic infections and other HIV-related disorders were obtained from the patient medical records using predesigned data collection forms. All patients were clinically evaluated for the following AIDS-defining