An Overview of the Causes of Morbidity and Mortality among HIV infected Older Adults at Kenyatta National Hospital.
Abstract
Back-ground
The HIV epidemic is aging due to increased life expectancy among those on Highly Active
Antiretroviral Therapy (HAART) and a significant number of poorly reported new infections in
the older adult. Several studies have demonstrated a drastic decline in AIDS morbidity and
mortality and an increase in non AIDS morbidity and mortality among HIV infected persons.
Aging complicates HIV infection as it is accompanied by physiological changes that affect
immunity, metabolism and overall systemic well-being. This has an impact on response to
HAART, drug toxicity and comorbidity. Moreover, older adults are more likely to be diagnosed
in the late stages of HIV and therefore have poorer outcomes.
Study objective
To determine the causes of morbidity and mortality among HIV infected older adults who were
enrolled and accessed services at the Kenyatta National Hospital (KNH) from 1 st June 2011 to
31 st May 2013.
Methodology
A cross-sectional retrospective study was carried out at KNH. Data from 389 randomly selected
adults aged 50 years and older as of 2011, who were served at the Comprehensive Care Clinic
(CCC) over the two year period, was analyzed. Data was derived from patient files on sociodemographics, medications, HIV parameters, morbidity and mortality using a standardized data
abstraction tool.
VIII
Results
During the two year study period, 16.5% of persons who accessed services at the center were
older adults. In total 389 participants were included in the study; the mean age of participants
was 58.5 years with a male to female ratio of 0.96:1. Overall, 74% of all subjects had morbidity
other than HIV and the prevalence of late stage HIV disease among those diagnosed within the
study period was 50%. The commonest non-infectious conditions were hypertension, diabetes
and chronic kidney disease with prevalence of 35.5%, 11.6% and 10.8% respectively whereas
the leading causes of infectious conditions were pulmonary tuberculosis (9%) and pneumonia
(3.6%). Non-AIDS defining and AIDS defining cancers had comparable prevalence of 2.3% and
2.6% in this cohort. Due to these comorbidities, the prevalence of polypharmacy was 70%
though drug interactions were documented in only 0.3% of the population. Adverse drug
reactions occurred in 22% of all subjects and accounted for 9% of all admissions. The
admissions due to infectious conditions and non-infectious conditions were comparable with
prevalence of 53.6% and 51.5% respectively of all admissions. 6 out of the 8 deaths reported
within the study were due to AIDS.
Conclusion
This study confirms that HIV infected older adults in our setting are facing a double burden of
comorbidities; age related pathology and HIV associated complications. In light of the increasing
proportion of HIV infected older adults, more needs to be done in terms of research. This
information will be crucial in managing and scaling up programs targeting this unique subset of
those living with HIV.
Citation
Institute of Tropical and Infectious DiseasePublisher
University of Nairobi