HIV prevalence and morbidity in older in-patients in a high HIV prevalence setting

Abstract

Introduction Current understanding of the burden of human immunodeficiency virus (HIV) infection and chronic illnesses in patients aged 50 years and over is limited, especially in low- and middle-income countries. Antiretroviral therapy (ART) has increased life expectancy of HIV positive individuals, exposing them to age related chronic illnesses. Objectives To compare the demographic and disease profiles, including chronic illnesses of hospitalised patients aged 50 years and over by HIV status admitted to a regional hospital in South Africa. Methods Patients aged 50 years and older admitted on Sundays, Mondays and Thursdays to Tshepong Hospital Medical Wards from November 2015 to February 2016 were approached to participate. These days were selected as a representative sample of admissions without recruiting every day, as the principal investigator and assistant could not collect data daily due to other responsibilities. Socio-demographic data, laboratory results, anthropometric data, discharge diagnoses and HIV status were collected. Patient characteristics were stratified by HIV status and gender. The Kruskal-Wallis test was used to compare the continuous variables and p-values were obtained. Variables with p-value ≤ 0.05 were considered as significant. Results A total of 478 eligible patients were admitted over the study period and 151 participants were enrolled. Their median age was 61 years (IQR: 56-68 years); 89 were women (58.9%). Overall 47 (31.1%) were HIV positive, of whom 10 (6.6 %) were newly diagnosed at this admission. The HIV positive group was younger [median age 57.0 years (IQR: 53.0-62.0)] compared to HIV negative group [median age 64.3 years (IQR: 57.0-71.0 years)] (p-value<0.0001). The most common discharge diagnoses amongst all participants was acute gastroenteritis (11.5%) and community acquired pneumonia (11.5%). Hypertension and type 2 diabetes mellitus (T2DM) were the most common chronic illnesses in HIV negative, known HIV positive and newly diagnosed HIV positive participants respectively (Hypertension: 75.0%, 59.46% and 40.0%) (T2DM: 22.1%, 24.3%). Eighteen patients died during admission; 12 were HIV negative (p-value= 0.8617). Conclusion Almost a third of older patients admitted to hospital were HIV positive, whose leading cause for hospitalisation was infections. Although in the ART era, older patients have similar age-related chronic illnesses irrespective of HIV status.