Lucas S B, Hounnou A, Peacock C, Beaumel A, Djomand G, N'Gbichi J M, Yeboue K, Hondé M, Diomande M, Giordano C
Projet RETRO-CI, Abidjan, Côte d'Ivoire.
AIDS. 1993 Dec;7(12):1569-79. doi: 10.1097/00002030-199312000-00005.
HIV disease is epidemic in Africa, but associated mortality, underlying pathology and CD4+ T-lymphocyte counts have not previously been evaluated in a representative study. Such data help to determine the management of HIV-positive people. Both HIV-1 and HIV-2 infections are prevalent in Côte d'Ivoire, and the pathology of HIV-2 infection in Africa is unclear.
Consecutive adult medical admissions to a large city hospital in Côte d'Ivoire were studied in 1991, and a sample of HIV-positive deaths autopsied.
Of 5401 patients evaluated, 50% were HIV-positive; 38% of these died, with a median survival of 1 week. At autopsy (n = 294, including 24% of HIV-positive deaths in hospital), tuberculosis (TB), bacteraemia (predominantly Gram-negative rods) and cerebral toxoplasmosis caused 53% of deaths. TB was seen in 54% of cadavers with AIDS-defining pathology and Pneumocystis pneumonia in 4%. The median CD4+ T-lymphocyte counts in those who died was < 90 x 10(6)/l. Compared with HIV-1-positives, patients with HIV-2-positivity had a greater frequency of severe cytomegalovirus infection, HIV encephalitis and cholangitis.
In this population, HIV-positive adults present to hospital with advanced disease associated with high mortality. The three major underlying pathologies (TB, toxoplasmosis and bacteraemia) are either preventable or treatable. TB is an underestimated cause of the 'slim' syndrome in Africa. The patterns of pathology in HIV-2-positive patients suggest a more prolonged terminal course compared with HIV-1. There is an urgent need for attention towards the issues of therapy and care for HIV disease in developing countries.
艾滋病在非洲流行，但此前尚未在一项具有代表性的研究中对其相关死亡率、潜在病理以及 CD4 + T 淋巴细胞计数进行评估。此类数据有助于确定对艾滋病毒呈阳性者的管理方式。艾滋病毒 1 型和 2 型感染在科特迪瓦均很普遍，而非洲艾滋病毒 2 型感染的病理情况尚不清楚。
1991 年对科特迪瓦一家大城市医院连续收治的成年患者进行了研究，并对艾滋病毒呈阳性死亡者的样本进行了尸检。
在评估的 5401 名患者中，50% 为艾滋病毒呈阳性；其中 38% 死亡，中位生存期为 1 周。尸检时（n = 294，包括医院内 24% 的艾滋病毒呈阳性死亡者），结核病、菌血症（主要为革兰氏阴性杆菌）和脑弓形虫病导致了 53% 的死亡。在具有艾滋病界定病理的尸体中，54% 可见结核病，4% 可见肺孢子菌肺炎。死亡者的 CD4 + T 淋巴细胞计数中位数 < 90×10⁶ /L。与艾滋病毒 1 型呈阳性者相比，艾滋病毒 2 型呈阳性患者严重巨细胞病毒感染、艾滋病毒脑炎和胆管炎的发生率更高。
在这一人群中，艾滋病毒呈阳性成年患者就医时病情已发展到晚期，死亡率很高。三种主要潜在病理（结核病、弓形虫病和菌血症）要么可预防，要么可治疗。结核病是非洲“消瘦”综合征一个被低估的病因。与艾滋病毒 1 型相比，艾滋病毒 2 型呈阳性患者的病理模式表明其终末期病程更长。发展中国家迫切需要关注艾滋病毒疾病的治疗和护理问题。
