In-hospital mortality of acute HIV-associated pulmonary morbidity among COVID-19 negative medical admissions to Dr. George Mukhari Academic Hospital

Abstract

Objectives: Human immunodeficiency virus (HIV)-related complications remain a frequent cause of hospital admissions. Pulmonary complications are among the most frequent causes of morbidity and mortality in HIV-infected individuals. We aimed to describe the in-hospital mortality of medical admissions with an acute HIV-associated pulmonary pathology. Materials and Methods: This was an observational study undertaken at a tertiary care center over 12 months. Variables of interest were as follow: Diagnoses, diagnostic work-up, treatment, mortality rate, and impact of comorbidities and HIV-associated factors on mortality. Results: Two-hundred and seventy-two patients were studied. The mean age was 42.0 ± 10.8 years. Males constituted 62.4% of the cases. One hundred and thirty patients (47.8%) were anti-retroviral therapy (ART) naive. The median CD4 count was 76 cells/mm3. The most frequent pulmonary diagnosis was community-acquired pneumonia (CAP) (212; 78%). Gram-negative pathogens were isolated in the majority of patients admitted with infectious complications. Pulmonary tuberculosis (PTB) was confirmed in only 27 (0.9%) of the cases. Significantly more female patients were on ART compared to males (P = 0.0436). Survival rates were not significantly different between the two genders (P = 0.1670). Overall, in-hospital mortality was 25.7%. CD4 counts and comorbidities were not predictive of mortality. Conclusion: HIV-associated acute pulmonary disease is associated with significant mortality. A large number of patients are diagnosed at an advanced stage of HIV. Programs that encourage voluntary testing and treatment are likely to reduce the high number of late presentations and reduce the poor outcomes. Adherence to the South African thoracic society guideline recommended evaluation for PTB in HIV-infected patients diagnosed with CAP cannot be over-emphasized.