title: Prevalence and indicators of HIV and AIDS among adults admitted to medical and surgical wards in Blantyre, Malawi.
abstract: Despite high seroprevalence there are few recent studies of the effect of human immunodeficiency virus (HIV) on hospitals in sub-Saharan Africa. We examined 1226 consecutive patients admitted to medical and surgical wards in Blantyre, Malawi during two 2-week periods in October 1999 and January 2000: 70% of medical patients were HIV-positive and 45% had acquired immune deficiency syndrome (AIDS); 36% of surgical patients were HIV-positive and 8% had AIDS. Seroprevalence rose to a peak among 30-40 year olds; 91% of medical, 56% of surgical and 80% of all patients in this age group were HIV-positive. Seropositive women were younger than seropositive men (median age 29 vs. 35 years, P < 0.0001). Symptoms strongly indicative of HIV were history of shingles, chronic diarrhoea or fever or cough, history of tuberculosis (TB), weight loss and persistent itchy rash (adjusted odds ratios [AORs] all > 5). Clinical signs strongly indicative of HIV were oral hairy leukoplakia, shingles scar, Kaposi's sarcoma, oral thrush and hair loss (AORs all > 10). Of surgical patients with 'deep infections' (breast abscess, pyomyositis, osteomyelitis, septic arthritis and multiple abscesses), 52% were HIV-positive (OR compared with other surgical patients = 2.4). Severe bacterial infections, TB and AIDS caused 68% of deaths. HIV dominates adult medicine, is a major part of adult surgery, is the main cause of death in hospital and affects the economically active age group of the population.
authors.affiliation: Department of Medicine, University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi.
authors.forename: David K
authors.initials: DK
authors.lastname: Lewis
authors.forename: Maria
authors.initials: M
authors.lastname: Callaghan
authors.forename: Kamija
authors.initials: K
authors.lastname: Phiri
authors.forename: James
authors.initials: J
authors.lastname: Chipwete
authors.forename: James G
authors.initials: JG
authors.lastname: Kublin
authors.forename: Eric
authors.initials: E
authors.lastname: Borgstein
authors.forename: Ed E
authors.initials: EE
authors.lastname: Zijlstra
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D015528:HIV Seroprevalence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D014504:Urban Health