1 in 4 Die of Acute Infections in South African City with High HIV Rate

New research suggests that too many patients with acute infections are dying in one South African city affected by high rates of HIV and TB.

At the recent annual meeting of the Society for Academic Emergency Medicine (SAEM), emergency medicine researchers from Johns Hopkins Medicine presented findings from their research on emergency department patients in South Africa.

Since 2010, South Africa has seen a 49% decrease in HIV infections and a 29% decrease in AIDS-related deaths, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). Nevertheless, the country continues to have the largest HIV epidemic in the world. In 2016, South Africa had an estimated 7.1 million individuals living with HIV, 270,000 new HIV infections, and 110,000 AIDS-related deaths. In sub-Saharan Africa, coinfection with HIV and tuberculosis (TB) is all too common; in fact, TB causes most AIDS-related deaths in South Africa. In 2017, the country’s minister of health launched a 9-month drug regimen to fight multidrug-resistant TB, following news that South Africa and several countries were set to miss the 2020 target of cutting HIV-associated TB deaths by 75%.

On May 17, 2018, at the SEAM meeting, a team of Johns Hopkins Medicine researchers shared the results of their study on patients with acute infectious illnesses who had been admitted to a Mthatha, South Africa emergency department. The study, which has yet to be published, included patients admitted from July 8 to August 31, 2017, in the Eastern Cape city of Mthatha, where a 2011 study found the HIV prevalence rate to be 13.7%. The researchers enrolled a total of 301 subjects in the study, 51.8% of whom had HIV and 32.9% of whom had a history of TB infection. They conducted follow-up interviews either in the hospital or via telephone 30 days from index visit.

Of the patients enrolled, 165 patients had complete 30-day follow-up. While 52.5% of the patients were diagnosed with a respiratory infection, 23.6% had suspected cases of active TB. The authors found that within 30 days of presentation, 25.2% of patients died. The study, say the authors, is South Africa’s first prospective study describing the epidemiology and risk factors for mortality of emergency department patients with acute infections.

“South Africa is very unique, and that’s because of its unbelievably high prevalence of HIV, and a good proportion of those patients also have a history of TB,” said the study’s first author, Alexander Jenson, MD, MPH, in an interview with Contagion®. He says that their findings highlight the importance of screening for HIV in emergency departments in the region, and show that HIV affects the emergent health condition of patients. He emphasizes that more than one-third of those with HIV died within 30 days, whereas less than 20% of those without HIV died.

“This study shows not only that infectious illness has a huge 30-day mortality risk, but that HIV itself quadruples your odds of mortality independent of all other risk factors and reasons why you came to the hospital,” said Dr. Jenson. The study’s findings will be applied to developing site-specific management strategies for patients with chronic infectious illness and acute infectious illness and can help lay the groundwork for different protocols for managing infectious illness than are needed in the developed world.