Cause-specific mortality amongst Retroviral Disease patients admitted in a tertiary health facility in northeastern Nigeria- a retrospective analysis

Ballah Akawu Denue

Abstract


Abstract

Background: Compared with the general population, HIV infected patients are at an additional risk of death from direct effects of HIV virus and/or immune dysfunction.

Aim: To establish the cause(s) of death among persons with HIV and AIDS admitted to the infectious diseases and immunology unit of University of Maiduguri Teaching Hospital.

Methods: Retrospective chart review of hospital deaths between January 2004 to December 2014 . Information was abstracted from case file and death certificates.

Results: Of the 115 total deaths, 64 (55.7%), 45 (39.1% and 6 (5.2%) were due to AIDS related, HIV related and non-AIDS or HIV related diseases respectively. Patients aged 16 -49 years constituted 87(87.9%).  HIV associated wasting syndrome was the most common cause of AIDS related deaths. It was responsible for (46.8%), it was followed by oesophageal candidiasis  (19.4%) and Pneumocystis jiroveci (13.0%). Severe sepsis was the commonest cause of HIV related deaths, it was responsible for 27.9% of cases, it was followed by TB 25% (Disseminated 13.6%, Tuberculoma 10% and Multi Drug Resistant form 1.4%) and HIV associated nephropathy (HIVAN), 12.3%.

Conclusion: Patients admitted with advanced HIV disease in WHO clinical stages III and IV are at risk of death from HIV related diseases or AIDS defining illness. HIV associated wasting syndrome, sepsis and tuberculosis are common cause of death in patients with advanced HIV disease in our setting. The finding from this study suggests missed opportunities for early diagnosis and treatment of HIV infected patients exist in our environment.


Keywords


HIV/AIDS, Cause of death, Northeastern Nigeria.

References


References

Brinkhof MWG, Dabis F, Myer L, Bangsberg DR, Boulle A, Nash A, Schechter M, Laurent C, Keiser O, May M, Sprinz E, Egger M, Anglaret X . Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries. Bulletin of the World Health Organization 2008; 86:559–567.

Gupta A, Nadkarni G, Yang W-T, Chandrasekhar A, Gupte N, et al. Early Mortality in Adults Initiating Antiretroviral Therapy (ART) in Low- and Middle-Income Countries (LMIC): A Systematic Review and Meta-Analysis. PLoS ONE 2011; 6(12): e28691. doi:10.1371/journal.pone.0028691.

National Agency for Control of AIDS (NACA), “National HIV/AIDS Response Fact Sheet 2011, Update on HIV/AIDS Epidemic and Response in Nigeria,” August 2012, http:/www.naca.gov.ng/.

Braitstein P, Brinkhof MW, Dabis F, Schechter M, Boulle A, et al. Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet 2006; 367: 817– 824.

Weber, R., Ruppik, M., Rickenbach, M., Spoerri, A., Furrer, H., Battegay, M., Cavassini, M., Calmy, A., Bernasconi, E., Schmid, P., Flepp, M., Kowalska, J. & Ledergerber, B.; Swiss HIV Cohort Study (SHCS). Decreasing mortality and changing patterns of causes of death in the Swiss HIV cohort study. HIV Med. 2013;14, 195-207

Towards universal access by 2010: How WHO is working with countries to scale-up HIV prevention, treatment, care and support. Geneva: WHO; 2007. Available from: https://www.who.int/hiv/mediacentre/universal_access_progress_report_en.pdf [accessed on 22 April 2018].

JC2484_treatment-2015_en.pdf [Internet]. [cited 2018 Aug 27]. Available from:http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2013/JC2484_treatment-2015_en.pdf.

Sani MU, Mohammed AZ, Adamu B, Yusuf SM, Samaila AA, Borodo MM, “AIDS mortality in a tertiary health institution: a four-year review. Journal of the National Medical Association. 2006; 98(6): 862–866.

Gyuse AN, Bassey IE, Udonwa NE, Okokon IB, Philip-Ephraim EE. HIV/AIDS related mortality among Adult medical patients in a tertiary health institution in South- South, Nigeria. Asian Pacific Journal of Tropical Medicine. 2010;3(2):141-144.

World Health Organization. Interim WHO clinical staging of HIV/AIDS and HIV/AIDS case definitions for surveillance: African region: World Health Organization; 2005.

Centers for Disease Control and prevention. Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. JAMA 1993;269: 729 – 730.

Egger M, May M, Chene G, Phillips AN, Ledergerber B, Dabis F, Costagliola D, D’Arminio MA, de Wolf F, Reiss P, Lundgren JD, Justice AC, Staszewski S, Leport C, Hogg RS, Sabin CA, Gill MJ, Salzberger B, Sterne JA: Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002, 360(9327):119–129

Hogg RS, Yip B, Chan KJ, Wood E, Craib KJ, O’Shaughnessy MV, Montaner JS: Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. JAMA 2001, 286(20):2568–2577.

Fleishman JA, Hellinger FH: Recent trends in HIV-related inpatient admissions 1996–2000: a 7-state study. J Acquir Immune Defic Syndr 2003, 34(1):102–110.

Etard J-F, Ndiaye I, Thierry-Mieg M, Guèye NFN, Guèye PM, Lanièce I, et al. Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal: a 7- year cohort study. AIDS Lond Engl. 2006 May 12;20(8):1181–9.

Asante-Quashie A, Essel A, Kenu E, Ganu V, Neequaye A. Causes of death in Hospitalized HIV Patients in the early Anti-Retroviral Therapy era M. Lartey, Ghana Medical Journal. 2015; 49(1): 7-11

Ojini FI, Coker A. Socio-demographic and clinical features of HIV-positive outpatients at a clinic in south-west Nigeria. African Journal of AIDS Research. 2007;6(2):139–145.

Akolo C, Ukoli CO, Ladep GN, Idoko JA. The clinical features of HIV/AIDS at presentation at the Jos University Teaching Hospital. Nigerian Journal of Medicine. 2008;17(1):83–87.

Denue BA, Gashau W, Alkali MB, Bukbuk Y, Akawu CB, Yelima J. Socio-demographic and clinical pattern of presentation of HIV-1 infected adult in North – Eastern Nigeria. International Journal of Current Research. 2012;4(4):147 – 151.

Onyemelukwe GC, Musa BO, “CD4+ and CD8+ lymphocytes and clinical features of HIV seropositive Nigerians on presentation,” African Journal of Medicine and Medical Sciences.2002;32(2): 229–233.

Agaba PA, Digin E, Makai R et al. Clinical characteristics and predictors of mortality in hospitalized HIV-infected Nigerians,” Journal of Infection in Developing Countries. 2011; 5(5): 377–382.

Sobhani R, Basavaraj A, Gupta A et al. Mortality & clinical characteristics of hospitalized adult patients withHIV in Pune, India, Indian Journal of Medical Research. 2007; 126(2): 116–121.

Belay H, Alemseged F, Angesom T, Hintsa S, Abay M. Effect of late HIV diagnosis on HIV-related mortality among adults in general hospitals of Central Zone Tigray, northern Ethiopia: a retrospective cohort study. Research and Palliative Care. 2017; 9 : 187–192.

Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med. 2009; 360: 1815–1826.

Sterne JA, May M, Costagliola D, de Wolf F, Phillips AN, et al. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet. 2009; 373: 1352–1363.

Ogoina D, Obiako RO, Muktar HM, Adeiza M, Babadoko A, Hassan A, Bansi I, Iyanda IH, Ajayi ET. Morbidity and Mortality Patterns of Hospitalised Adult HIV/AIDS Patients in the Era of Highly Active Antiretroviral Therapy: A 4-year Retrospective Review from Zaria, Northern Nigeria. AIDS Research and Treatment Volume 2012, Article ID 940580, doi:10.1155/2012/940580

Nicastri E, Leone S, Angeletti C, Palmisano L, Sarmati L, et al. Sex issues in HIV-1-infected persons during highly active antiretroviral therapy: a systematic review. J Antimicrob Chemother 2007; 60: 724–732.

Garko SB, Ekweani CN, Anyiam CA. Duration of hospital stay and mortality in the medical wards of Ahmadu Bello University Teaching Hospital, Kaduna. Annals of African Medicine. 2003;2(2): 68–71.

Kolo P, Chijioke A. Gender disparities in mortalityamong medical admissions of a tertiary health facility in Ilorin, Nigeria. The Internet Journal of Tropical Medicine. 2009 vol.6, article 1.

Alibhai A, Kipp W, Saunders LD, Senthilselvan A, Kaler A, et al. Gender-related mortality for HIV-infected patients on highly active antiretroviral therapy (HAART) in rural Uganda. Int J Womens Health 2010; 2: 45–52.

Kumarasamy N, Venkatesh KK, Cecelia AJ, Devaleenol B, Saghayam S, et al. Gender-based differences in treatment and outcome among HIV patients in South India. J Womens Health. 2008; 17: 1471–1475.

WHO: Gender and HIV/AIDS, November 2003, http://www.who.int/.


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