Abstract Background Advanced HIV disease (AHD) remains a major contributor to hospitalization and inpatient mortality across sub-Saharan Africa. In resource-limited settings, restricted access to diagnostics for opportunistic infections (OIs) often results in delayed or empirical treatment, impacting outcomes. Despite a reported lower national HIV prevalence compared to neighboring countries, evidence on the clinical burden and management of hospitalized people living with HIV (PLWHIV) in The Gambia is scarce. Methods We conducted a retrospective cohort study of adults and children with confirmed HIV admitted to the Clinical Services Department of the MRC Unit The Gambia between February 2020 and April 2025. The study was undertaken within the context of a quality improvement project to quantify the burden of AHD, including opportunistic infections, diagnostic capacity, treatment practices, disease severity (assessed using adult MEWS), and inpatient outcomes, using anonymised electronic medical record data. Results Among 258 patients (214 adults, 44 children), adults had a mean age of 43.5 years and 65% were female; 97.3% had advanced HIV disease (27.9% WHO stage III, 69.4% stage IV), and with high clinical burden: 46.3% of adults had MEWS ≥7 at admission. OIs and severe bacterial infections (BIs) were common and mostly diagnosed clinically. Tuberculosis (TB) investigations (GeneXpert or sputum microscopy) were performed in 147 patients (57.0%), with treatment initiated in 87 (33.7%): 53 empirically and 34 microbiologically confirmed. Cryptococcal disease evaluation was limited, with antigen testing in 26 patients (10.1%) and lumbar puncture in 30 (11.6%). Blood cultures were obtained in 77.0% of patients at admission (85.1% among those with MEWS ≥7), yielding 24 clinically significant isolates, most commonly Salmonella spp., Escherichia coli, Streptococcus spp./S.pneumoniae, and Staphylococcus aureus. Empirical antibiotics were prescribed to 203 patients, with ceftriaxone being the most frequently used agent (49%). Inpatient mortality was 12.0%, higher among those with elevated MEWS and those receiving TB treatment, particularly empirically. Conclusions Hospitalized PLWHIV with AHD at MRCG present with severe illness and a high burden of BIs and OIs, managed largely empirically due to limited diagnostic resources. Strengthening access to essential diagnostics and promoting earlier HIV diagnosis may enable targeted therapy, reduce disease severity at admission, and potentially improve inpatient outcomes.
Bonadiman et al. (Wed,) studied this question.