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. 2014 Apr 7;17(1):18797.
doi: 10.7448/IAS.17.1.18797. eCollection 2014.

Disease patterns and causes of death of hospitalized HIV-positive adults in West Africa: a multicountry survey in the antiretroviral treatment era

Charlotte Lewden  1 , Youssoufou J Drabo  2 , Djimon M Zannou  3 , Moussa Y Maiga  4 , Daouda K Minta  5 , Papa S Sow  6 , Jocelyn Akakpo  3 , François Dabis  7 , Serge P Eholié  8 ; IeDEA West Africa Collaboration
Collaborators, Affiliations

Disease patterns and causes of death of hospitalized HIV-positive adults in West Africa: a multicountry survey in the antiretroviral treatment era

Charlotte Lewden et al. J Int AIDS Soc. .

Abstract

Objective: We aimed to describe the morbidity and mortality patterns in HIV-positive adults hospitalized in West Africa.

Method: We conducted a six-month prospective multicentre survey within the IeDEA West Africa collaboration in six adult medical wards of teaching hospitals in Abidjan, Ouagadougou, Cotonou, Dakar and Bamako. From April to October 2010, all newly hospitalized HIV-positive patients were eligible. Baseline and follow-up information until hospital discharge was recorded using standardized forms. Diagnoses were reviewed by a local event validation committee using reference definitions. Factors associated with in-hospital mortality were studied with a logistic regression model.

Results: Among 823 hospitalized HIV-positive adults (median age 40 years, 58% women), 24% discovered their HIV infection during the hospitalization, median CD4 count was 75/mm(3) (IQR: 25-177) and 48% had previously received antiretroviral treatment (ART). The underlying causes of hospitalization were AIDS-defining conditions (54%), other infections (32%), other diseases (8%) and non-specific illness (6%). The most frequent diseases diagnosed were: tuberculosis (29%), pneumonia (15%), malaria (10%) and cerebral toxoplasmosis (10%). Overall, 315 (38%) patients died during hospitalization and the underlying cause of death was AIDS (63%), non-AIDS-defining infections (26%), other diseases (7%) and non-specific illness or unknown cause (4%). Among them, the most frequent fatal diseases were: tuberculosis (36%), cerebral toxoplasmosis (10%), cryptococcosis (9%) and sepsis (7%). Older age, clinical WHO stage 3 and 4, low CD4 count, and AIDS-defining infectious diagnoses were associated with hospital fatality.

Conclusions: AIDS-defining conditions, primarily tuberculosis, and bacterial infections were the most frequent causes of hospitalization in HIV-positive adults in West Africa and resulted in high in-hospital fatality. Sustained efforts are needed to integrate care of these disease conditions and optimize earlier diagnosis of HIV infection and initiation of ART.

Keywords: AIDS; Africa; HIV infection; antiretroviral therapy; hospitalization; morbidity.

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References

    1. CASCADE. Collaboration Determinants of survival following HIV-1 seroconversion after the introduction of HAART. Lancet. 2003;362:1267–74. - PubMed
    1. The Antiretroviral Therapy in Lower Income Countries (ART-LINC) Collaboration. The Antiretroviral Therapy (ART) Cohort Collaboration. Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet. 2006;367:817–24. - PubMed
    1. Laurent C, Diakhate N, Gueye NFN, Toure MA, Sow PS, Faye MA, et al. The Senegalese government's highly active antiretroviral therapy initiative: an 18-month follow-up study. AIDS. 2002;16:1363–70. - PubMed
    1. Seyler C, Messou E, Gabillard D, Inwoley A, Alioum A, Anglaret X. Morbidity before and after HAART initiation in Sub-Saharan African HIV-infected adults: a recurrent event analysis. AIDS Res Hum Retroviruses. 2007;23:1338–47. - PubMed
    1. UNAIDS. Global report. UNAIDS Report on the global AIDS epidemic2013 [Internet] 2013. [cited 2013 Nov 12]. Available from: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiolo....

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