Abstract:
Objective: To determine admissions diagnosis and outcomes of HIV-infected patients
attending AMPATH ambulatory HIV-care clinics.
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 most
common 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.
