Prevalence and indicators of HIV and AIDS among adults admitted to medical and surgical wards in Blantyre, Malawi.

Despite high seroprevalence there are few recent studies of the effect of HIV on hospitals in sub-Saharan Africa. We examined 1226 consecutive patients admitted during two 2-week periods in October 1999 and January 2000. 70% medical patients were HIV positive, and 45% had AIDS. 36% surgical patients were HIV positive and 8% had AIDS. Seroprevalence rose to a peak among 30-40 year olds; 91% medical, 56% surgical and 80% all patients in this age group were HIV positive. Seropositive women were younger than seropositive men (median age 29 v 35, p<0.0001). Symptoms strongly indicative of HIV were history of shingles, chronic diarrhoea or fever or cough, history of tuberculosis, weight loss, and persistent itchy rash (adjusted odds ratios all over 5). Clinical signs strongly indicative of HIV were oral hairy leukoplakia, shingles scar, Kaposi's sarcoma, oral thrush, and hair loss (adjusted odds ratios all over 10). Of surgical patients with 'deep infections' (breast abscess, pyomyositis, osteomyelitis, septic arthritis, and multiple abscesses), 52% were HIV positive (OR compared with other surgical patients 2.4). Severe bacterial infections, tuberculosis, and AIDS caused 68% deaths. HIV dominates adult medicine, is a major part of adult surgery, is the main cause of death in hospital, and affects the economically active age group of the population.