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.