TY - JOUR
T1 - Inpatient mortality rates during an era of increased access to HIV testing and ART
T2 - A prospective observational study in Lilongwe, Malawi
AU - Matoga, Mitch M.
AU - Rosenberg, Nora E.
AU - Stanley, Christopher C.
AU - LaCourse, Sylvia
AU - Munthali, Charles K.
AU - Nsona, Dominic P.
AU - Haac, Bryce
AU - Hoffman, Irving
AU - Hosseinipour, Mina C.
N1 - Publisher Copyright:
© 2018 Matoga et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2018/2
Y1 - 2018/2
N2 - Background In the era of increased access to HIV testing and antiretroviral treatment (ART), the impact of HIV and ART status on inpatient mortality in Malawi is unknown. Methods We prospectively followed adult inpatients at Kamuzu Central Hospital medical wards in Lilongwe, Malawi, between 2011 and 2012, to evaluate causes of mortality, and the impact of HIV and ART status on mortality. We divided the study population into five categories: HIV-negative, new HIV-positive, ART-naïve patients, new ART-initiators, and ART-experienced. We used multivariate binomial regression models to compare risk of death between categories. Results Among 2911 admitted patients the mean age was 38.5 years, and 50% were women. Eighty-one percent (81%) of patients had a known HIV status at the time of discharge or death. Mortality was 19.4% and varied between 13.9% (HIV-negative patients) and 32.9% (HIV-positive patients on ART 1 year). In multivariable analyses adjusted for age, sex and leading causes of mortality, being new HIV-positive (RR = 1.64 95% CI: 1.16–2.32), ART-naive (RR = 2.28 95% CI: 1.66–2.32) or being a new ART-initiator (RR = 2.41 95% CI: 1.85–3.14) were associated with elevated risk of mortality compared to HIV-negative patients. ART-experienced patients had comparable mortality (RR = 1.33 95% CI: 0.94–1.88) to HIV-negative patients. Conclusion HIV related mortality remains high among medical inpatients, especially among HIV-positive patients who recently initiated ART or have not started ART yet.
AB - Background In the era of increased access to HIV testing and antiretroviral treatment (ART), the impact of HIV and ART status on inpatient mortality in Malawi is unknown. Methods We prospectively followed adult inpatients at Kamuzu Central Hospital medical wards in Lilongwe, Malawi, between 2011 and 2012, to evaluate causes of mortality, and the impact of HIV and ART status on mortality. We divided the study population into five categories: HIV-negative, new HIV-positive, ART-naïve patients, new ART-initiators, and ART-experienced. We used multivariate binomial regression models to compare risk of death between categories. Results Among 2911 admitted patients the mean age was 38.5 years, and 50% were women. Eighty-one percent (81%) of patients had a known HIV status at the time of discharge or death. Mortality was 19.4% and varied between 13.9% (HIV-negative patients) and 32.9% (HIV-positive patients on ART 1 year). In multivariable analyses adjusted for age, sex and leading causes of mortality, being new HIV-positive (RR = 1.64 95% CI: 1.16–2.32), ART-naive (RR = 2.28 95% CI: 1.66–2.32) or being a new ART-initiator (RR = 2.41 95% CI: 1.85–3.14) were associated with elevated risk of mortality compared to HIV-negative patients. ART-experienced patients had comparable mortality (RR = 1.33 95% CI: 0.94–1.88) to HIV-negative patients. Conclusion HIV related mortality remains high among medical inpatients, especially among HIV-positive patients who recently initiated ART or have not started ART yet.
UR - https://www.scopus.com/pages/publications/85041502372
U2 - 10.1371/journal.pone.0191944
DO - 10.1371/journal.pone.0191944
M3 - Article
C2 - 29415015
AN - SCOPUS:85041502372
SN - 1932-6203
VL - 13
JO - PLoS ONE
JF - PLoS ONE
IS - 2
M1 - e0191944
ER -