title: Causes of hospital admission among people living with HIV worldwide: a systematic review and meta-analysis.
abstract: BACKGROUND
  Morbidity associated with HIV infection is poorly characterised, so we aimed to investigate the contribution of different comorbidities to hospital admission and in-hospital mortality in adults and children living with HIV worldwide.
  
  
  METHODS
  Using a broad search strategy combining terms for hospital admission and HIV infection, we searched MEDLINE via PubMed, Embase, Web of Science, LILACS, AIM, IMEMR and WPIMR from inception to Jan 31, 2015, to identify studies reporting cause of hospital admission in people living with HIV. We focused on data reported after 2007, the period in which access to antiretroviral therapy started to become widespread. We estimated pooled proportions of hospital admissions and deaths per disease category by use of random-effects models. We stratified data by geographical region and age.
  
  
  RESULTS
  We obtained data from 106 cohorts, with reported causes of hospital admission for 313 006 adults and 6182 children living with HIV. For adults, AIDS-related illnesses (25 119 patients, 46%, 95% CI 40-53) and bacterial infections (14 034 patients, 31%, 20-42) were the leading causes of hospital admission. These two categories were the most common causes of hospital admission for adults in all geographical regions and the most common causes of mortality. Common region-specific causes of hospital admission included malnutrition and wasting, parasitic infections, and haematological disorders in the Africa region; respiratory disease, psychiatric disorders, renal disorders, cardiovascular disorders, and liver disease in Europe; haematological disorders in North America; and respiratory, neurological, digestive and liver-related conditions, viral infections, and drug toxicity in South and Central America. For children, AIDS-related illnesses (783 patients, 27%, 95% CI 19-34) and bacterial infections (1190 patients, 41%, 26-56) were the leading causes of hospital admission, followed by malnutrition and wasting, haematological disorders, and, in the African region, malaria. Mortality in individuals admitted to hospital was 20% (95% CI 18-23, 12 902 deaths) for adults and 14% (10-19, 643 deaths) for children.
  
  
  CONCLUSIONS
  This review shows the importance of prompt HIV diagnosis and treatment, and the need to reinforce existing recommendations to provide chemoprophylaxis and vaccination against major preventable infectious diseases to people living with HIV to reduce serious AIDS and non-AIDS morbidity.
  
  
  BACKGROUND
  None.
authors.affiliation: Department of HIV/AIDS, WHO, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa. Electronic address: fordn@who.int.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
authors.forename: Zara
authors.initials: Z
authors.lastname: Shubber
authors.affiliation: Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Ministry of Health, Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: Unit of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Abidjan, Côte d'Ivoire.
authors.forename: Serge
authors.initials: S
authors.lastname: Eholie
authors.affiliation: Global Evaluative Sciences, Vancouver, BC, Canada.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
authors.affiliation: Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa.
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.affiliation: Department of HIV/AIDS, WHO, Geneva, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Vitoria
authors.affiliation: Department of HIV/AIDS, WHO, Geneva, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Penazzato
authors.affiliation: Rwanda Biomedical Center, Institute of HIV Disease Prevention and Control, Kigali, Rwanda; Swiss Tropical and Public Health Research Institute and Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel, Switzerland.
authors.forename: Sabin
authors.initials: S
authors.lastname: Nsanzimana
authors.affiliation: Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, University of Stellenbosch, Cape Town, South Africa.
authors.forename: Lisa
authors.initials: L
authors.lastname: Frigati
authors.affiliation: Manson Unit, Médecins Sans Frontières, London, UK; Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: O'Brien
authors.affiliation: South Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa.
authors.forename: Tom
authors.initials: T
authors.lastname: Ellman
authors.affiliation: Clinton Health Access Initiative, Boston, MA, USA.
authors.forename: Olawale
authors.initials: O
authors.lastname: Ajose
authors.affiliation: HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
authors.affiliation: Department of HIV/AIDS, WHO, Geneva, Switzerland.
authors.forename: Meg
authors.initials: M
authors.lastname: Doherty
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D002100:Cachexia / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis