CLINICAL STUDY OF MORBIDITY AND MORTALITY OF PEOPLE LIVING WITH HIV (PLHIV) ADMITTED TO A TERTIARY HEALTH CENTRE IN GUNTUR, ANDHRA PRADESH
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2016, Vol 3, Issue 5
Abstract
INTRODUCTION Guntur district, which forms part of the AP state capital region, tops the list of HIV positive cases in the state. The district also had the dubious distinction of being the “HIV capital” in undivided Andhra Pradesh in the last two years. A proportion of the many patients who have advanced AIDS in Guntur diagnosed lately present for the first time requiring admission to hospital. AIM The aim of the study is to describe the clinical condition, inpatient case management and outcomes before discharge of people living with HIV admitted in Tertiary Health Centre in Guntur, Andhra Pradesh. MATERIAL AND METHODS This was an observational, analytic, prospective cohort study using a sample of all patients consecutively admitted in tertiary health centre from March 2015 to September 2015. Patients were divided into two groups, ART Group and non-ART Group. ART Group includes all the patients who were started immediately on Anti-retroviral Therapy (ART) before their discharge. Non-ART Group contains patients who did not received ART or who were terminally ill to start ART. Prevalence of opportunistic infections, morbidity and mortality outcomes of the two groups before discharge were determined. RESULTS Among the cohort of 203 PLHIV enrolled during the study period, only 85(42%) were initiated on ART immediately. In all patients, tuberculosis (67;35%) was the most common opportunistic infection followed by extra pulmonary tuberculosis (63; 31%) and Pneumocystis pneumonia (35;19%). The mean baseline CD4 cell count was 84 cells/uL for the non-ART group and 55 cells/uL for the ART group (p <0.01). The median duration from time of initial admission to ART initiation was 14 days. The median duration of stay from initial admission to discharge from hospital was 13 days in the NON ART group and 18 days in the ART group. The mortality before discharge among the non-ART group was 24% compared to 6% among the ART group (p =0.001). Immune reconstitution inflammatory syndrome was diagnosed in three patients (4%) among the admissions, but caused no deaths. CONCLUSIONS Average CD4 count is lower in patients admitted with AIDS defining illness. Tuberculosis co-infection contributes the largest burden of disease and was diagnosed in two thirds of all admissions. Starting ART as soon as it can be tolerated (within 2 weeks) after anti-tuberculosis therapy will be of great benefit in reducing mortality. Most patients stayed for a median of four days after the ART initiation. This was crucial to monitor and treat anticipated adverse events and drug toxicities from combined opportunistic infection treatment and ART.
Authors and Affiliations
Kalyan Kumar P. V, Ramakrishna Gorantla, Kolla Sravani, Venu Venu, Nageswararao G, Indira D
Keywords
Related Articles
- EP ID EP232032
- DOI 10.18410/jebmh/2016/39
- Views 112
- Downloads 0
IS GROUP A B-HAEMOLYTIC STREPTOCOCCUS PREVALENT AMONG THE CHILDREN WITH TONSILLO-PHARYNGITIS? A SCHOOL HEALTH SURVEY BASED STUDY IN PONDICHERRY
BACKGROUND The morbidity due to Tonsillo-Pharyngitis in children following a Group A Streptococcus (GAS) is very important in ENT practice. It accounts to more than 25% of all the bacterial infections. The aim of this st...
CAPILLARY HEMANGIOMA OF THE PARANASAL SINUSES
OBJECTIVE: To report a case of ethmoid sinus capillary hemangioma and to discuss its management and treatment options with special mention on the clinical presentation, radiographic features and surgical options. METHOD:...
EVALUATION OF RENOMEGALY BY ULTRASOUND IN A RURAL POPULATION
BACKGROUND Renomegaly is easily picked up by ultrasound examination. Improved computer technology led to improved resolution which further made Ultrasonography the 1st line of investigation in the evaluation of renomegal...
A STUDY ON VARIOUS MODES OF PRESENTATION OF GASTROINTESTINAL TUBERCULOSIS AT EMERGENCY, ITS MANAGEMENT AND OUTCOMES
Abdominal tuberculosis is the 6th most common form of extrapulmonary tuberculosis, among which ileocaecal tuberculosis is most common. Tuberculosis has been declared a global emergency by the World Health Organization (W...
COMPARISON OF PREVALENCE OF DRY EYE IN PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN IN A TERTIARY CARE CENTRE IN SOUTHERN INDIA
BACKGROUND Ocular symptoms due to dry eye is the most frequently encountered problem in the old age, especially in females. Owing to fluctuating levels of various hormones in the female body with advancing age, various h...