ADMISSION CHARACTERISTICS, DIAGNOSES AND OUTCOMES OF HIV-INFECTED PATIENTS REGISTERED IN AN AMBULATORY HIV-CARE PROGRAMME IN WESTERN KENYA

Abstract

Objective: To determine admissions diagnosis and outcomes of HIV-infected patients

attending.

Design: Prospective cohort study.

Setting: Academic Model for prevention and Treatment of HIV/ AIDS (AMPATH)

ambulatory HIV-care clinic in western Kenya.

Results: Between January 2005 and December 2006, 495 HIV-infected patients enrolled

in AMPATH were admitted. Median age at admission was 38 years (range: 19 - 74),

62% females, 375 (76%) initiated cART a median 56 days (range: 1- 1288) before

admission. Majority (53%) had pre-admission CD4 counts <100 cells/ml and 23%

had counts >200 cells/ml. Common admissions diagnoses were: tuberculosis (27%);

pneumonia (15%); meningitis (11%): diarrhoea (11%); malaria (6%); severe anaemia

(4%); and toxoplasmosis (3%). Deaths occurred in 147 (30%) patients who enrolled at

AMPATH a median 44 days (range: 1 - 711 ) before admission and died a median 41

days (range: 1 -713) after initiating cART. Tuberculosis (27%) and meningitis (14%)

were the commonest diagnoses in the deceased. Median admission duration was six

days (range: 1 - 30) for deceased patients and eight days (range: I - 44) for survivors (P

= 0.0024). Deceased patients enrolled in AMPATH or initiated cART more recently, had

lower CD4 counts and were more frequently lost to follow-up than survivors (P<0.05

for each comparison). Initiation of cART before admission and clinic appointment

adherence were independent predictors of survival.

Conclusion: Although high mortality rate is seen in HIV-infected in-patients. Those

initiating cART before admission were more likely to survive.