Lewden Charlotte, Drabo Youssoufou J, Zannou Djimon M, Maiga Moussa Y, Minta Daouda K, Sow Papa S, Akakpo Jocelyn, Dabis François, Eholié Serge P
Université de Bordeaux, ISPED, Centre INSERM U897, Bordeaux, France; INSERM, Centre INSERM U897, Bordeaux, France;
Department of Internal Medicine, University Hospital Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
J Int AIDS Soc. 2014 Apr 7;17(1):18797. doi: 10.7448/IAS.17.1.18797. eCollection 2014.
We aimed to describe the morbidity and mortality patterns in HIV-positive adults hospitalized in West Africa.
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.
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.
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.
我们旨在描述西非地区住院的HIV阳性成年人的发病和死亡模式。
我们在阿比让、瓦加杜古、科托努、达喀尔和巴马科的教学医院的六个成人内科病房内，于IeDEA西非合作项目中开展了一项为期六个月的前瞻性多中心调查。2010年4月至10月期间，所有新入院的HIV阳性患者均符合条件。使用标准化表格记录直至出院的基线和随访信息。诊断由当地事件验证委员会根据参考定义进行审核。采用逻辑回归模型研究与院内死亡相关的因素。
在823名住院的HIV阳性成年人中（中位年龄40岁，58%为女性），24%在住院期间发现感染HIV，中位CD4细胞计数为75/立方毫米（四分位间距：25 - 177），48%此前接受过抗逆转录病毒治疗（ART）。住院的根本原因是艾滋病界定疾病（54%）、其他感染（32%）、其他疾病（8%）和非特异性疾病（6%）。最常诊断出的疾病为：结核病（29%）、肺炎（15%）、疟疾（10%）和脑弓形虫病（10%）。总体而言，315名（38%）患者在住院期间死亡，死亡的根本原因是艾滋病（63%）、非艾滋病界定感染（26%）、其他疾病（7%）以及非特异性疾病或不明原因（4%）。其中，最常见的致命疾病为：结核病（36%）、脑弓形虫病（10%）、隐球菌病（9%）和败血症（7%）。年龄较大、世界卫生组织临床分期3期和4期、CD4细胞计数低以及艾滋病界定感染诊断与医院死亡相关。
艾滋病界定疾病，主要是结核病和细菌感染，是西非地区HIV阳性成年人住院最常见的原因，并导致了较高的院内死亡率。需要持续努力整合这些疾病的治疗，并优化HIV感染的早期诊断及ART的启动。
