Characteristics and Predictors of Death among Hospitalized HIV-Infected Patients in a Low HIV Prevalence Country: Bangladesh

PLOS ONE, Dec 2019

Background Predictors of death in hospitalized HIV-infected patients have not been previously reported in Bangladesh. Objective The primary aim of this study was to determine predictors of death among hospitalized HIV-infected patients at a large urban hospital in Bangladesh. Methods A study was conducted in the HIV in-patient unit (Jagori Ward) of icddr,b's Dhaka Hospital. Characteristics of patients who died during hospitalization were compared to those of patients discharged from the ward. Bivariate analysis was performed to determine associations between potential risk factors and death. Multivariable logistic regression was used to identify factors independently associated with death. Results Of 293 patients admitted to the Jagori Ward, 57 died during hospitalization. Most hospitalized patients (67%) were male and the median age was 35 (interquartile range: 2–65) years. Overall, 153 (52%) patients were diagnosed with HIV within 6 months of hospitalization. The most common presumptive opportunistic infections (OIs) identified were tuberculosis (32%), oesophageal candidiasis (9%), Pneumocystis jirovecii pneumonia (PJP) (8%), and histoplasmosis (7%). On multivariable analysis, independent predictors of mortality were CD4 count ≤200 cells/mm3 (adjusted odds ratio [aOR]: 16.6, 95% confidence interval [CI]: 3.7–74.4), PJP (aOR: 18.5, 95% CI: 4.68–73.3), oesophageal candidiasis (aOR: 27.5, 95% CI: 5.5–136.9), malignancy (aOR:15.2, 95% CI: 2.3–99.4), and bacteriuria (aOR:7.9, 95% CI: 1.2–50.5). Being on antiretroviral therapy prior to hospitalization (aOR: 0.2, 95% CI: 0.06–0.5) was associated with decreased mortality. Conclusion This study showed that most patients who died during hospitalization on the Jagori Ward had HIV-related illnesses which could have been averted with earlier diagnosis of HIV and proper management of OIs. It is prudent to develop a national HIV screening programme to facilitate early identification of HIV.

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Characteristics and Predictors of Death among Hospitalized HIV-Infected Patients in a Low HIV Prevalence Country: Bangladesh

December Characteristics and Predictors of Death among Hospitalized HIV-Infected Patients in a Low HIV Prevalence Country: Bangladesh Lubaba Shahrin * 0 1 2 6 7 Daniel T. Leung 2 3 6 7 Nashaba Matin 4 6 7 Mohammed Moshtaq Pervez 0 1 2 6 7 Tasnim Azim 2 6 7 Pradip Kumar Bardhan 0 6 7 James D. Heffelfinger 5 6 7 Mohammod Jobayer Chisti 0 1 6 7 0 Dhaka hospital, International Centre for Diarrheal Disease Research , Bangladesh (icddr,b), Dhaka , Bangladesh, 1 Centre for Nutrition and Food Security (CNFS), International Centre for Diarrheal Disease Research , Bangladesh (icddr,b), Dhaka , Bangladesh, 2 Centre for HIV/AIDS (CHIV), International Centre for Diarrheal Disease Research , Bangladesh (icddr,b), Dhaka , Bangladesh, 3 Centre for Vaccine Sciences (CVS), International Centre for Diarrheal Disease Research , Bangladesh (icddr,b), Dhaka , Bangladesh, 4 Royal London Hospital, Barts Health NHS Trust , London , United Kingdom, 5 Global Disease Detection Branch, Division of Global Health Promotion, Center for Global Health, Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia , United States of America 6 Funding: This research protocol was funded by the icddr,b and its donors who provide unrestricted support to this organization for its infrastructure (such as Dhaka Hospital) and research. Current donors providing unrestricted support include the following: Australian Agency for International Development (AusAID), Government of the People's Republic of Bangladesh, Canadian International Development Agency, Embassy of the Kingdom of Netherlands, Swedish International Development Cooperation Agency, Swiss Agency for Development and Cooperation and Department for International Development, UK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript 7 Editor: Antonio Guilherme Pacheco , FIOCRUZ , Brazil Background: Predictors of death in hospitalized HIV-infected patients have not been previously reported in Bangladesh. Objective: The primary aim of this study was to determine predictors of death among hospitalized HIV-infected patients at a large urban hospital in Bangladesh. Methods: A study was conducted in the HIV in-patient unit (Jagori Ward) of icddr,b's Dhaka Hospital. Characteristics of patients who died during hospitalization were compared to those of patients discharged from the ward. Bivariate analysis was performed to determine associations between potential risk factors and death. Multivariable logistic regression was used to identify factors independently associated with death. Results: Of 293 patients admitted to the Jagori Ward, 57 died during hospitalization. Most hospitalized patients (67%) were male and the median age was 35 (interquartile range: 2-65) years. Overall, 153 (52%) patients were diagnosed with HIV within 6 months of hospitalization. The most common presumptive opportunistic infections (OIs) identified were tuberculosis (32%), oesophageal candidiasis (9%), Pneumocystis jirovecii pneumonia (PJP) (8%), and histoplasmosis (7%). On multivariable analysis, independent predictors of mortality Bangladesh were CD4 count #200 cells/mm3 (adjusted odds ratio [aOR]: 16.6, 95% confidence interval [CI]: 3.774.4), PJP (aOR: 18.5, 95% CI: 4.6873.3), oesophageal candidiasis (aOR: 27.5, 95% CI: 5.5136.9), malignancy (aOR:15.2, 95% CI: 2.3 99.4), and bacteriuria (aOR:7.9, 95% CI: 1.250.5). Being on antiretroviral therapy prior to hospitalization (aOR: 0.2, 95% CI: 0.060.5) was associated with decreased mortality. Conclusion: This study showed that most patients who died during hospitalization on the Jagori Ward had HIV-related illnesses which could have been averted with earlier diagnosis of HIV and proper management of OIs. It is prudent to develop a national HIV screening programme to facilitate early identification of HIV. As of 2012, an estimated 35.3 million people were living with human immunodeficiency virus (HIV) globally and among them 2.3 million were newly infected [1]. In the Asia Pacific region, the estimated number of new HIV infections was 350,000 (220,000550,000) and the number of AIDS-related deaths across the region was 270,000 (190,000360,000) [2]. By the end of 2013, the Ministry of Health and Family Welfare (MOHFW) of Bangladesh had documented 3,241 persons with confirmed HIV, including 1,299 persons who developed AIDS and 472 persons who had died [3]. With an estimated HIV prevalence of ,0.1% in the general population [3], Bangladesh has been considered a low HIV prevalence country [4] since the first case was detected in 1989 [5]. Despite these low numbers, Bangladesh is one of the nine countries in the world in which the estimated HIV incidence increased by .25% between 2001 and 2011 [6]. Diagnosis of HIV in Bangladesh is often delayed for a variety of reasons, including lack of awareness of HIV infection due to its low prevalence, the limited number of HIV testing and counseling facilities, (...truncated)


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Lubaba Shahrin, Daniel T. Leung, Nashaba Matin, Mohammed Moshtaq Pervez, Tasnim Azim, Pradip Kumar Bardhan, James D. Heffelfinger, Mohammod Jobayer Chisti. Characteristics and Predictors of Death among Hospitalized HIV-Infected Patients in a Low HIV Prevalence Country: Bangladesh, PLOS ONE, 2014, Volume 9, Issue 12, DOI: 10.1371/journal.pone.0113095