P. V. Kalyan Kumar1, Ramakrishna Gorantla2, Ramakrishna Rachakonda3, Kolla Sravani4, Venu5, Nageswararao G6, Indira D7
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.
