HIV remains a major cause of inpatient clinical burden in Zimbabwe in the Antiretroviral Therapy era with a growing contribution of morbidity and mortality due to cancer

Abstract

Objective: To evaluate pattern of disease within a tertiary hospital in Zimbabwe, and determine the relative contribution of HIV infection to infectious and non-communicable disease burden, inpatient mortality and length of hospital stay.
Design: Retrospective cohort analysis.
Setting: Parirenyatwa Hospital, Harare, Zimbabwe.
Main Outcome Measures: Disease burden, mortality and length-of-stay for1002 consecutive adult admissions.
Results: Median age was 41 years, 53% were female. HIV prevalence among those with a known HIV status was 61.7%, 20% were above age 55 years; 63.5% were on ART with a median duration on ART of 4 years (IQR 2.5-7). Among inpatients, 20.3%, 16.1% and 11% carried an infectious disease, neoplasm and circulatory disorders diagnosis. Those with a malignancy were older (median age 55 vs. 39 years, p=<0.0001). Median length of hospital stay was 4 days (IQR2-8) and longer in HIV infected patients (5 vs. 4 days, p=<0.0001). Inpatient mortality was 12.1%, and higher among those with known HIV infection (17.9%) compared with those without (11.1%) or whose status was unknown (10.4%, p=0.013). Median age at death was lower in those with HIV infection (40 vs. 66 years, p=<0.0001). Among those age 55 years or older who died, a diagnosis of cancer was present in 34.2%. HIV infection was associated with a two fold increased risk of death (aOR 1.96, 95%CI 1.2-3.1, p=0.05).
Conclusion: HIV infection remains a significant cause of morbidity and mortality among in-patients in Africa, an increasing number are on long-term ART with increasing age. Cancers are however becoming an increasingly important cause of in-patient morbidity and mortality.