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AIDS Research and Treatment


Volume 2020, Article ID 1872358, 7 pages
https://doi.org/10.1155/2020/1872358

Research Article
Hospitalization and Predictors of Inpatient Mortality among
HIV-Infected Patients in Jimma University Specialized Hospital,
Jimma, Ethiopia: Prospective Observational Study

Kirubel Minsamo Mishore ,1 Nezif Hussein,2 and Solomon Assefa Huluka 3

1
School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
2
Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
3
Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, P.O.Box 1176,
Addis Ababa, Ethiopia

Correspondence should be addressed to Solomon Assefa Huluka; solomon.assefa@aau.edu.et

Received 12 August 2019; Revised 31 March 2020; Accepted 24 April 2020; Published 27 May 2020

Academic Editor: Bhaskaran Unnikrishnan

Copyright © 2020 Kirubel Minsamo Mishore et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Despite the number of patients enrolled in ART is increased, HIV/AIDS continues to constitute a significant proportion of
medical admissions and risk of mortality in low- and middle-income countries. As one of these countries, the case in Ethiopia is
not different. The aim of this study was thus to assess reasons for hospitalization, discharge outcomes, and predictors of inpatient
mortality among people living with HIV (PLWH) in Jimma University Specialized Hospital (JUSH), Jimma, Southwest Ethiopia.
Prospective observational study was conducted in medical wards of JUSH from February 17th to August 17th, 2017. In this study,
101 PLWH admitted during the study period were included. To identify the predictors of mortality, multiple logistic regression
analysis was employed. Of the 101 hospitalized PLWH, 62 (61.4%) of them were females and most of them (52.5%) were between
25 and 34 years of age. A majority (79.2%) of the study participants were known HIV patients, before their admission. Tu-
berculosis (24.8%), infections of the nervous system (18.8%), and pneumonia (9.9%) comprised more than half of the reasons for
hospitalization. Moreover, drug-related toxicity was a reason for hospitalization of 6 (5.9%) patients. Outcomes of hospitalization
indicated that the overall inpatient mortality was 18 (17.8%). The median CD4 cell counts for survivors and deceased patients were
202 cells/μL (IQR, 121–295 cells/μL) and 70 cells/μL (IQR, 42–100 cells/μL), respectively. Neurologic complications (AOR = 13.97;
95% CI: 2.32–84.17, P � 0.004), CD4 count ≤ 100 cells/μl (AOR = 16.40; 95% CI: 2.88–93.42, P � 0.002), and short hospital stay
(AOR = 12.98, 95% CI: 2.13–78.97, P � 0.005) were found to be significant predictors of inpatient mortality. In conclusion,
opportunistic infections are the main reason of hospitalization in PLWH.

1. Introduction HIV-affected regions [3]. In such low- and middle-income


countries, HIV and its associated immunosuppression
Globally, close to 35 million people are believed to live with (AIDS) continue to constitute a significant deal of morbidity
HIV. Sub-Saharan Africa, worst affected region, in particular and mortality in adults. In some of these countries, the
accounts for 71% of HIV infections [1]. Life expectancy for problem is acute [4–6].
patients infected with HIV has improved significantly in the In resource-poor settings, between 20% and 52% of
era of highly active antiretroviral therapy (HAART) [2]. The hospital beds in medical wards are occupied by HIV-infected
decline in hospitalization due to HAART, however, has been patients at any given time, mostly with opportunistic in-
unevenly distributed and inconsistent. Despite the global fections [7] and ended up with longer hospital stays [8].
decrease in AIDS-related death and improvement of access Furthermore, it is reported that non-HIV-related hospital-
to HAART, eastern and southern Africa remain the most izations of HIV-infected patients is increasing, globally [9].
2 AIDS Research and Treatment

Most reports of hospitalization from HIV infection in the era medication and reported as good (≥95%), fair (85 to 95%), or
of HAART are from the developed countries [10–13]. This is poor (<85%) if and only if they missed 2 and less, 3 to 5, or 6
mainly because publications reporting HIV-related hospi- and more doses, respectively [16]. Data were collected by
talization from developing countries are infrequent. hospital pharmacists, working in medical wards, after being
Data on the spectrum of both HIV- and non-HIV-re- trained on interview techniques, data collection methods,
lated illnesses that result in hospital admission are essential and techniques of measurements. Moreover, to determine
for policymakers and stakeholders to plan actions in re- the outcomes of hospitalization, they followed the patients
ducing morbidity, mortality, and further hospitalization prospectively until discharged or died.
[14]. Recently, Negera and Mega [15] reported that body
mass index (BMI) of less than 18.5 is a significant predictor
of inpatient mortality in Ethiopia. However, with the paucity 2.4. Data Processing and Analysis. Data were coded, entered,
of published data on HIV/AIDS in Ethiopia, little is known cleaned, and analyzed using SPSS version 20 statistical
about other reasons for hospitalizations, discharge out- package. Bivariate and multivariate logistic regression an-
comes, and predictors of inpatient mortality in hospitalized alyses with 95% confidence interval were employed in order
patients with HIV. Thus, this study aimed to assess reasons to infer associations and predictions. In bivariate analysis, all
for hospitalization, discharge outcomes, and predictors of explanatory variables that are associated with the outcome
inpatient mortality among people living with HIV in Jimma variable (inpatient mortality) with a P value of <0.2 were
University Specialized Hospital (JUSH), Jimma, Southwest included in the final logistic model. P value < 0.05 was
Ethiopia. considered as statistically significant for all the independent
variables in the final model.
2. Methods
2.5. Ethical Consideration. Letter of ethical clearance was
2.1. Study Area and Period. This study was conducted from
obtained from the Ethical Review Board of College of Public
17th February to 14th August 2017 in medical wards of JUSH,
Health and Medical Sciences, Jimma University. Informed,
which is the only teaching and referral hospital in Southwest
voluntary, written, and signed consent/assent was obtained
Ethiopia. The hospital provides services for approximately
from each study participants/caregivers. Privacy and con-
9000 inpatient and 80,000 outpatient attendants a year from
fidentiality were strictly maintained throughout the study.
the catchment population of about 15 million people. It has
more than 450 beds. In this hospital, the HIV test was
performed using the HIV 1/2 STAT-PAK1 RDT (Chembio 3. Results
Diagnostics, Medford, NY, USA) kit. In JUSH, Mycobac-
3.1. Sociodemographic Characteristics of the Study Population.
terium tuberculosis diagnosis was made using the Xpert assay
Of 101 hospitalized PLWH enrolled in the study, 62 (61.4%)
(Cepheid Xpert MTB/RIF ).
® of them were females and 53 (52.5%) of the patients were
between 25 and 34 years of age. Most of the study partic-
2.2. Study Design and Participants. A hospital-based pro- ipants were urban residents (64.4%) and unemployed
spective observational study was employed. The study (62.4%). As it is illustrated in Table 1, the measured mean
population included 101 patients who met the following BMI of patients was 17.63 ± 3.24 kg/m2. Slightly more than
criteria: HIV seropositive (either known prior to hospital- one-third of the patients (34.8%) had severe malnutrition
ization or tested positive following hospitalization), adult (BMI < 16 kg/m2).
patients (≥15 years), admitted to medical wards of JUSH in
the study period, willing to participate in the study, and
stayed for at least 24 hours in the inpatient wards. To confirm 3.2. Clinical Characteristics of the Participants. Clinical
HIV status of patients, every hospitalized patient underwent characteristics and laboratory findings of the patients are
provider-initiated counseling and testing (PICT). presented in Tables 2 and 3, respectively. The result showed
that 21 (20.8%) of participants were newly diagnosed HIV-
positive patients (tested on hospitalization). For known HIV
2.3. Data Collection and Data Quality. Patient demo- patients (79.2%), the median duration of time since their
graphics, anthropometric measurements, reason for hos- diagnosis was 24 months (IQR, 6–60). Majority (82.2%) of
pitalization, comorbidities, complications, laboratory the patients were in WHO clinical stage 4 and 44.6% of them
profile, and HAART status were collected using a prede- had complications. The main (46.7%) complication of the
signed data collection form. All CD4 cell counts included in hospitalized patient was severe neurologic dysfunctions.
study analyses were either done during hospitalization or More than a quarter (27.7%) of the participants had a history
within the previous 1 month before hospitalization. The of prior hospitalization in the last 12 months, and oppor-
clinical staging of patients was carried out using WHO tunistic infections were the leading (53.6%) reasons for their
guidelines for the clinical staging of HIV/AIDS for adults. previous hospitalization (Table 2).
Adherence to HAART was assessed for 46 patients who In this study, 29 (28.7%) of the patients had CD4 cell
were on HAART for at least 6 months prior to their ad- counts of ≤100 cells/μL (IQR, 93.5–279.0). The median CD4
mission. Adherence was estimated from patients’ self-report cell count for survivors and died was 202 cells/μL (IQR,
of missed doses out of 30 doses of their prescribed 121–295) and 70 cells/μL (IQR, 42–100), respectively
AIDS Research and Treatment 3

Table 1: Sociodemographic characteristics of PLWH hospitalized deceased, of whom 12 (66.7%) died within the first 7 days of
to the medical wards of JUSH, Jimma, Southwest Ethiopia, 2017 their hospital stay.
(N � 101).
Characteristics Frequency Percent 3.5. Factors Associated with Inpatient Mortality. Both uni-
Sex variate and multivariate logistic regression analyses (Table 5)
Male 39 38.6 showed that presence of neurologic complications, CD4
Female 62 61.4 count ≤ 100 cell/μL, and hospital stay of less than 7 days were
Age group predictors of inpatient mortality. PLWH hospitalized with
15–24 8 7.9 neurologic complications were almost fourteen times more
25–34 53 52.5
likely to die inpatient compared with those who were not
35–44 25 24.7
45+ 15 14.9
(AOR � 13.97; 95% CI: 2.32–84.17, P � 0.004). The odds of
dying inpatient were significantly (P � 0.002) higher in PLWH
Residence
Urban 65 64.4
hospitalized with CD4 count ≤ 100 cells/μl compared with CD4
Rural 36 35.6 count > 100 cells/μL (AOR � 16.40; 95% CI: 2.88–93.42).
Level of education
No education 29 28.7 4. Discussion
Primary 42 41.6
Secondary+ 30 29.7 In this study, opportunistic and other infectious diseases
Marital status were dominant attributes of hospitalization. The spectrum of
Single 15 14.8 opportunistic infection is in agreement with previous re-
Married 50 49.5 ports on hospitalized HIV/AIDS patients from other parts of
Divorced 25 24.8
Ethiopia [17–19] and other low- and middle-income
Widowed 11 10.9
countries [3, 5, 20–23]. Our study, however, reported a
Occupation
relatively lower proportion of TB. This could be because of
Government employee 10 9.9
Self-employed 28 27.7
the better availability of free HAART, which determines the
Unemployed 63 62.4 frequency and severity of opportunistic infections such as
active TB disease [7, 18, 24].
Body mass index (in kg/m2)
<16 35 34.7 The prevalence of CNS infections observed during our
16–18.5 23 22.7 study period was 18.8%. This is in line with a similar study
18.5–24.9 43 42.6 conducted in Kenya [25] and lower than other studies
≥25 0 0.0 [26, 27]. The common CNS infections identified were
cryptococcal meningitis (36.8%), bacterial meningitis
(31.6%), and cerebral toxoplasmosis (31.6%). This propor-
(Table 3). Anemia was reported in 88 of 96 (85.4%) patients tion of CNS infections was consistent with other studies
(defined as hemoglobin (Hg) < 13 gm/dL for males and <12 [3, 15, 20, 28–30]. HAART-related toxicity was also among
gm/dL for females), and it was severe (Hg < 8gm/dL) in 21 the commonly occurred reasons for hospitalization. Proper
(21.9%) of them. counseling about the adverse effects of antiretroviral drugs
and aggressive monitoring of patients before and within the
first few weeks of commencement of HAART will help to
3.3. Antiretroviral Therapy Regimen of Patient on HAART.
reduce morbidity associated with the use of these drugs.
Among 80 known HIV patients, 65 (81.2%) of them were on
The overall inpatient mortality in our study population was
HAART with the median duration of 19.00 (IQR,
17.8%, similar to previous reports [3, 23, 31]. Our finding,
3.25–40.25) months and majority (89.2%) of them were on
nevertheless, was higher than previous studies in India [6] and
first-line regimen. About a third (16; 34.8%) of the
France [30]. The high mortality is probably reflective of the
patients,who were assessed for adherence, had a poor
advanced nature of the disease during hospitalization [10, 20].
(<85%) HAART adherence. Among 19 (29.2%) patients who
Although there were differences in study design, a higher
had regimen changes, treatment failure was found to be the
mortality rate was reported in other studies [16, 20, 21, 32].
leading (36.8%) reason for treatment switch (Table 4).
Logistic regression analysis showed that presentation
with neurologic complications, low CD4 count (≤100 cells/
3.4. Reasons for Hospitalization and Treatment Outcome of μl), and short duration of hospital stay (<7 days) were
Hospitalized Patients. Tuberculosis (TB) was the most predictors of inpatient mortality. Multiple studies reported a
common diagnosis that accounted for 25 (24.8%) of the statistically significant association of low CD4 cell counts as
reasons for hospitalization (Figure 1). The median duration the predictor of inpatient mortality [20, 33]. HIV patients
of hospital stay for the patients was found to be 13 days (IQR, hospitalized with neurologic complications were almost 14
8–20 days). As it is revealed in Figure 2, 82.2% of the ad- times more likely to die inpatient compared with those
mitted patients survived: 69 (68.3%) discharged, 10 (9.9%) of without neurologic complications. This is in accordance with
them discharge against medical advice (DAMA), and 4 findings from other studies from Ethiopia by Berhe et al. [34]
(4.0%) transferred cases. The remaining 18 (17.8%) were and elsewhere by Gill et al. [35].
4 AIDS Research and Treatment

Table 2: Clinical characteristics of PLWH hospitalized to medical wards of JUSH, Jimma, Southwest Ethiopia, 2017.
Characteristics Category Frequency Percent
Known 80 79.2
HIV status at admission
New 21 20.8
<6 months 21 26.3
Duration of HIV in month (N � 80)
≥6 months 59 73.7
Stage 1 5 5.0
Stage 2 2 2.0
Clinical stage of HIV/AIDS on hospitalization
Stage 3 13 13.0
Stage 4 81 80.2
Neurologic 21 46.7
Respiratory 14 31.1
Hypovolemic shock 2 4.4
Complication (N � 45)
Hepatic encephalopathy 2 4.4
Gastric bleeding 2 4.4
Nephropathy 2 4.4
Cardiovascular 8 36.4
Gastrointestinal 5 22.7
Comorbidity (N � 22)
Urologic 5 22.7
Respiratory 4 18.2
Opportunistic infections 15 53.6
DVT 2 7.1
COPD∗ 2 7.1
Reasons for hospitalization (known HIV-positive patients) in the last 12 months (N � 28)
Malaria 2 7.1
Bacterial meningitis 2 7.1
Not specified 5 17.9

Chronic obstructive pulmonary disease; DVT �deep venous thrombosis.

Table 3: Laboratory profile of PLWH hospitalized to the medical wards of JUSH, Jimma, Southwest Ethiopia, 2017.
Parameters Median (IQR) References
Hemoglobin (gm/dL) (N � 96) 9.75 (8.50–11.50) 12.0–17.0
Hematocrit (%) (N � 96) 30.24 (26.19–34.70) 40.0–54.0
Platelet (×109/L) (N � 93) 252.0 (149.50–402.0) 150–500
Aspartate aminotransferase (unit/L) (N � 77) 40.0 (21.40–80.50) 0–38
Alanine aminotransferase (unit/L) (N � 76) 25.25 (16.05–45.83) 0–40
Serum creatinine (mg/dL) (N � 70) 0.85 (0.68–1.29) 0.8–1.2
Blood urea nitrogen (mg/dL) (N � 70) 24.13 (14.38–41.54) 8–20
CD4 count (cells/μL) (N � 101) 193.0 (93.50–279.0) 500–1,500

Table 4: Antiretroviral therapy related characteristics of PLWH admitted to medical wards of JUSH, Jimma, Southwest Ethiopia, 2017.
Characteristics Category Frequency Percent
Yes 65 81.2
Prior HAART use (N � 80)
No 15 18.8
First line 58 89.2
Type of HAART regimen (N � 65)
Second line 7 10.8
TDF + 3TC + EFV 37 63.8
AZT + 3TC + NVP 11 19.0
First-line regimen (N � 58)
TDF + 3TC + NVP 5 8.6
Others 5 8.6
ABC + ddi + LPV/r 6 85.7
Second-line regimen (N � 7)
ABC + 3TC + LPV/r 1 14.3
Good 28 60.9
Adherence status among HAART users for ≥6 months (N � 46) Fair 2 4.3
Poor 16 34.8
AIDS Research and Treatment 5

Table 4: Continued.
Characteristics Category Frequency Percent
Yes 19 29.2
History of regimen change (N � 65)
No 46 70.8
Treatment failure 7 36.8
Toxicity/side effects 6 31.6
Reason for regimen change(N � 19)
Due to new TB 3 15.8
Others 3 15.8
Yes 51 63.8
Prior co-trimoxazole prophylaxis in known HIV patients (N � 80)
No 29 36.2

Others∗ 4
Acute kidney injury 2
Candidiasis (esophageal) 2
Chronic obstructive lung disease 2
Sepsis 3
Severe malaria (P.falciparum) 3
AIDS dementia complex 3
Acute viral hepatitis (HBsAg positive) 4
Chronic diarrhea 7
Zidovudine-related severe anemia 6
Pneumocystic carinii pneumonia 4
Bacterial pneumonia 6
Hypertensive heart failure 5
Deep venous thrombosis 6
Cerebral toxoplasmosis 6
Bacterial meningitis 6
Cryptococcal meningitis 7
Pulmonary tuberculosis 3
Extra pulmonary tuberculosis 22

Figure 1: Reasons for hospitalization of PLWH to medical wards of JUSH, Jimma, Southwest Ethiopia, 2017 (N � 101). ∗Chronic liver
disease, herpes zoster, cellulitis, and disseminated Kaposi sarcoma each accounts for 1.

4%
10%

18%

68%

Discharged DAMA
Died Referred

Figure 2: Discharge outcomes of PLWH admitted to the medical wards of JUSH, Jimma, Southwest Ethiopia, 2017 (N � 101).
6 AIDS Research and Treatment

Table 5: Univariate and multivariate analyses of factors associated with inpatient mortality among PLWH admitted to the medical wards of
JUSH, Jimma, Southwest Ethiopia, 2017 (N � 101).
Variables Category Died (N � 18) Survived (N � 83) COR (95% CI) P value∗ AOR (95% CI) P value∗
Male 10 (25.6%) 29 (74.4%) 2.33 (0.83–6.54) 0.109 0.57 (0.09–3.43) 0.539
Sex
Female 8 (12.9%) 54 (87.1%) 1.000 1.000
Yes 13 (61.9%) 8 (38.1%) 24.38 (6.89–86.19) 0.000 13.97 (2.32–84.17) 0.004
Neurologic complication
No 5 (6.2%) 75 (93.8%) 1.000 0.000 1.000
≤100 14 (48.3%) 15 (51.7%) 15.9 (4.57–6) 0.001 16.40 (2.88–93.42) 0.002
CD4 count
>100 4 (5.6%) 68 (94.4%) 1.000 1.000
<7 12 (46.2%) 14 (53.8%) 9.86 (3.17–30.69) 0.000 12.98 (2.13–78.97) 0.005
Hospital stay in days
≥7 6 (8.0%) 69 (92.0%) 1.000 1.000
COR � crude odds ratio; AOR : adjusted odds ratio; CI: confidence interval; ∗ P value <0.05 indicates a statistically significant association.

Our study has some limitations that should be consid- Acknowledgments


ered while interpreting the findings. They include the fol-
lowing: certain disease conditions might have been The authors would like to express appreciations to Jimma
overestimated or underestimated due to inadequate diag- University and the health facility where the research was
nostic facilities. Outcome measures for our study depended conducted. The authors would like to extend their appre-
on the survival status at last contact with our patient in the ciation to data collectors and medical ward clinical staffs for
hospital; we cannot exclude an underrepresentation of their support during data collection.
mortality rate as some DAMA patients might have died
outside our hospital. References
5. Conclusion [1] V. Ntlantsana, J. Richard, and P. Wendy, “HIV viraemia
during pregnancy in women receiving preconception anti-
Tuberculosis, infections of the nervous system, and pneu- retroviral therapy in KwaDukuza, KwaZulu-Natal,” Southern
monia were the top three leading reasons for hospitalization. African Journal of HIV Medicine, vol. 20, no. 1, pp. 1–8, 2019.
Furthermore, our study disclosed that presentation with [2] Z. Gheibi, Z. Shayan, H. Joulaei, F. Mohammad, B. Shohreh,
neurologic complication, low CD4 count, and short hospital and S. Mostafa, “Determinants of AIDS and non-AIDS related
stay were found to be predictors of inpatient mortality. mortality among people living with HIV in Shiraz, Southern
Iran: a 20-year retrospective follow-up study,” BMC Infectious
Diseases, vol. 19, p. 1094, 2019.
Abbreviations [3] A. Kumar, K. R. Kilaru, S. Sandiford, and S. Forde, “Trends in
the HIV related hospital admissions in the HAART era in
AIDS: Acquired immunodeficiency syndrome
Barbados, 2004–2006,” AIDS Research and Therapy, vol. 7,
CNS: Central nervous system no. 4, p. 4, 2007.
COPD: Chronic obstructive pulmonary disease [4] UNAIDS, “Global AIDS update 2016,” 2018, http://www.
DAMA: Discharge against medical advice unaids.org/sites/default/files/media_asset/global-AIDS-update-
DVT: Deep venous thrombosis 2016_en.pdf.
HAART: Highly active antiretroviral therapy [5] D. Ogoina, R. O. Obiako, H. M. Muktar et al., “Morbidity and
HIV: Human immunodeficiency virus mortality patterns of hospitalised adult HIV/AIDS patients in
IQR: Interquartile range the era of highly active antiretroviral therapy: a 4-year ret-
JUSH: Jimma University Specialized Hospital rospective review from Zaria, Northern Nigeria,” AIDS Re-
PLWH: People living with HIV search and Treatment, vol. 2012, Article ID 940580, 10 pages,
TB: Tuberculosis. 2012.
[6] A. D. Harries, A. B. Suthar, K. C. Takarinda et al., “Ending the
HIV/AIDS epidemic in low- and middle-income countries by
Data Availability 2030: is it possible?” F1000Research, vol. 5, p. 2328, 2016.
[7] H. Krentz, S. Dean, and M. Gill, “Longitudinal assessment
The data used to support the finding of this study are
(1995–2003) of hospitalizations of HIV-infected patients
available from the corresponding author upon request. within a geographical population in Canada,” HIV Medicine,
vol. 7, no. 7, pp. 457–466, 2006.
Disclosure [8] K. Falster, H. Wand, B. Donovan et al., “Hospitalizations in a
cohort of HIV patients in Australia, 1999–2007,” AIDS,
This study was done for the partial fulfillment Mr. Mishore’s vol. 24, no. 9, pp. 1329–1339, 2010.
master’s degree in clinical pharmacy. [9] B. P. Linas, B. Wang, M. Smurzynski et al., “The impact of
HIV/HCV co-infection on health care utilization and dis-
Conflicts of Interest ability: results of the ACTG longitudinal linked randomized
trials (ALLRT) cohort,” Journal of Viral Hepatitis, vol. 18,
The authors declare that they have no conflicts of interest. no. 7, pp. 506–512, 2011.
AIDS Research and Treatment 7

[10] M. U. Sani, A. Z. Mohammed, B. Adamu, S. M. Yusuf, [25] J. O. Jowi, P. M. Mativo, and S. S. Musoke, “Clinical and
A. A. Samaila, and M. M. Borodo, “AIDS mortality in a laboratory characteristics of hospitalized patients with neu-
tertiary health institution: a four-year review,” Journal of rological manifestations of HIV/AIDS at the Nairobi hospi-
National Medical Association, vol. 98, no. 6, pp. 862–866, tal,” East African Medical Journal, vol. 84, no. 2, pp. 67–76,
2006. 2007.
[11] A. Mocroft, A. d’Arminio Monforte, O. Kirk et al., “Changes [26] O. S. Abayomi, F. Ojini, N. Okubadejo et al., “Pattern and
in hospital admissions across Europe: 1995–2003. Results outcome of neurological manifestations of HIV/AIDS—a
from the EuroSIDA study,” HIV Medicine, vol. 5, no. 6, review of 154 cases in a Nigerian University Teaching Hos-
pp. 437–447, 2004. pital—a preliminary report,” African Journal of Neurological
[12] M. Floris-Moore, Y. Lo, R. S. Klein et al., “Gender and Sciences, vol. 24, no. 1, pp. 29–36, 2005.
hospitalization patterns among HIV-infected drug users be- [27] J. F. D. Oliveira, D. B. Greco, G. C. Oliveira, P. P. Christo,
fore and after the availability of highly active antiretroviral M. D. C. Guimarães, and R. C. Oliveira, “Neurological disease
therapy,” JAIDS Journal of Acquired Immune Deficiency in HIV-infected patients in the era of highly active anti-
Syndromes, vol. 34, no. 3, pp. 331–337, 2003. retroviral treatment: a Brazilian experience,” Revista da
[13] S. Paul, H. M. Gilbert, L. Lande et al., “Impact of antiretroviral Sociedade Brasileira de Medicina Tropical, vol. 39, no. 2,
therapy on decreasing hospitalization rates of HIV-infected pp. 146–151, 2006.
patients in 2001,” AIDS Research and Human Retroviruses, [28] M. J. Núñez, L. Martı́n-Carbonero, V. Moreno et al., “Impact
vol. 18, no. 7, pp. 501–506, 2002. of antiretroviral treatment-related toxicities on hospital ad-
[14] S. D. Lawn, A. D. Harries, and R. Wood, “Strategies to reduce missions in HIV-infected patients,” AIDS Research and Hu-
early morbidity and mortality in adults receiving anti- man Retroviruses, vol. 22, no. 9, pp. 825–829, 2006.
retroviral therapy in resource-limited settings,” Current [29] J. E. Sackoff, D. B. Hanna, M. R. Pfeiffer, and L. V. Torian,
Opinion in HIV and AIDS, vol. 5, no. 1, pp. 18–26, 2010. “Causes of death among persons with AIDS in the era of
[15] G. Z. Negera and T. A. Mega, “Clinical outcome of admitted highly active antiretroviral therapy: New York City,” Annals of
HIV/AIDS patients in Ethiopian tertiary care settings: a Internal Medicine, vol. 145, no. 6, pp. 397–406, 2006.
prospective cohort study,” PLoS One, vol. 14, no. 12, Article ID [30] C. Rapp, A. Reggad, A. Aoun, C. Ficko, D. Andriamanantena,
e0226683, 2019. and C. Flateau, “Hospitalisation causes of HIV-infected pa-
[16] D. Haile, A. Takele, K. Gashaw, H. Demelash, and D. Nigatu, tients in 2011 in an HIV reference center in the Paris region,
“Predictors of treatment failure among adult antiretroviral France,” Journal of the International AIDS Society, vol. 15,
treatment (ART) clients in bale zone hospitals, South Eastern no. 4, Article ID 18126, 2012.
Ethiopia,” PLoS One, vol. 11, no. 10, Article ID e0164299, 2016. [31] S. S. Dias, V. Andreozzi, M. O. Martins, and J. Torgal,
[17] A. Bane, A. G. Yohannes, and D. Fekade, “Morbidity and “Predictors of mortality in HIV-associated hospitalizations in
mortality of adult patients with HIV/AIDS at Tikur Anbessa Portugal: a hierarchical survival model,” BMC Health Services
Teaching Hospital, Addis Ababa, Ethiopia,” Ethiopian Med- Research, vol. 9, 2009.
ical Journal, vol. 41, no. 2, pp. 131–140, 2003. [32] C. A. Balkema, E. M. Irusen, J. J. Taljaard, M. D. Zeier, and
[18] G. Reniers, T. Araya, G. Davey et al., “Steep declines in C. F. Koegelenberg, “Prospective study on the outcome of
population-level AIDS mortality following the introduction of human immunodeficiency virus-infected patients requiring
antiretroviral therapy in Addis Ababa, Ethiopia,” AIDS, mechanical ventilation in a high-burden setting,” An Inter-
vol. 23, no. 4, pp. 511–518, 2009. national Journal of Medicine, vol. 109, no. 1, pp. 35–40, 2018.
[19] M. Tamiru and J. Haidar, “Hospital bed occupancy and HIV/ [33] H. N. Luma, B. C. Tchaleu, E. Temfack et al., “HIV-associated
AIDS in three major public hospitals of Addis Ababa, central nervous system disease in patients admitted at the
Ethiopia,” International Journal of Biomedical Sciences, vol. 6, Douala general hospital between 2004 and 2009: a retro-
no. 3, pp. 195–201, 2010. spective study,” AIDS Research and Treatment, vol. 2013,
[20] P. A. Agaba, E. Digin, R. Makai et al., “Clinical characteristics Article ID 709810, 6 pages, 2013.
and predictors of mortality in hospitalized HIV-infected [34] T. Berhe, Y. Melkamu, and A. Amare, “The pattern and
Nigerians,” The Journal of Infection in Developing Countries, predictors of mortality of HIV/AIDS patients with neurologic
vol. 5, no. 5, pp. 377–382, 2011. manifestation in Ethiopia: a retrospective study,” AIDS Re-
[21] M. Colvin, S. Dawood, I. Kleinschmidt, S. Mullick, and search and Therapy, vol. 9, no. 1, p. 11, 2012.
[35] J. K. Gill, L. Greene, R. Miller et al., “ICU admission in pa-
U. Lallo, “Prevalence of HIV and HIV-related diseases in the
tients infected with the human immunodeficiency virus—a
adult medical wards of a tertiary hospital in Durban, South
multicentre survey,” Anaesthesia, vol. 54, no. 8, pp. 727–732,
Africa,” International Journal of STD & AIDS, vol. 12, no. 6,
1999.
pp. 386–389, 2001.
[22] K. Thinyane and V. Cooper, “Clinical profiles of HIV-in-
fected, HAART-naive patients admitted to a tertiary level
hospital in Maseru, Lesotho,” The Internet Journal of Infec-
tious Diseases, vol. 11, no. 1, pp. 1–6, 2013.
[23] S. K Sharma, T. Kadhiravan, A. Banga, T. Goyal, I. Bhatia, and
P. K. Saha, “Spectrum of clinical disease in a series of 135
hospitalised HIV infected patients from North India,” BMC
Infectious Diseases, vol. 4, no. 52, 2004.
[24] B. E. Jones, S. M. M. Young, D. Antoniskis, P. T. Davidson,
F. Kramer, and P. F. Barnes, “Relationship of the manifes-
tations of tuberculosis to CD4 cell counts in patients with
human immunodeficiency virus infection,” American Review
of Respiratory Disease, vol. 148, no. 5, pp. 1292–1297, 1993.

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