title: Causes and outcome of hospitalization among HIV-infected adults receiving antiretroviral therapy in Mulago hospital, Uganda.
abstract: BACKGROUND
  Cohorts describing cause specific mortality in HIV-infected patients initiating antiretroviral therapy (ART) operate on an outpatient basis. Hospitalized patients represent the spectrum and burden of severe morbidity and mortality in patients on ART.
  
  
  OBJECTIVE
  To determine the causes and outcomes of hospitalization among adults receiving ART.
  
  
  METHODS
  A prospective cohort study. We enrolled 201 participants (50% female) with median (IQR) age and CD4 count of 34 (28-40) years and 91(29-211) cells/uL respectively.
  
  
  RESULTS
  The most frequent causes of hospitalization were tuberculosis (TB) (37, 18%), cryptococcal meningitis (22, 11%), zidovudine (AZT) - associated anemia (19, 10%), sepsis (10, 5%) and Kaposi's sarcoma (10, 5%). Forty two patients (21%) died: 10 (24%) had TB, 8 (19%) had cryptococcal meningitis and 5 (12%) had sepsis, 9 (21%) had undiagnosed neurological syndromes while 10 (24%) had other illnesses. Predictors of death included low Karnofsky performance score of < 40 (OR, 21.1; CI 1.43- 31.6) and age >34 years (OR, 7.65; CI 1.09- 53.8).
  
  
  CONCLUSIONS
  Opportunistic infections, malignancy and AZT-associated anemia contributed to most hospitalizations and mortality. It is important to intensify prevention, screening, and treatment for these opportunistic diseases and early ART initiation in HIV-infected patients. Tenofovir-based regimens, unless contraindicated should be scaled up to replace AZT-based regimens as first line ART drugs.
authors.affiliation: Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: A M N
authors.initials: AM
authors.lastname: Namutebi
authors.affiliation: Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: M R K
authors.initials: MR
authors.lastname: Kamya
authors.affiliation: Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: P
authors.initials: P
authors.lastname: Byakika-Kibwika
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D014454:Uganda / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents