Grant A D, Djomand G, Smets P, Kadio A, Coulibaly M, Kakou A, Maurice C, Whitaker J P, Sylla-Koko F, Bonard D, Wiktor S Z, Hayes R J, De Cock K M, Greenberg A E
Project RETRO-CL, London School of Hygiene and Tropical Medicine, UK.
AIDS. 1997 Sep;11(11):1357-64. doi: 10.1097/00002030-199711000-00010.
To describe the spectrum of opportunistic disease in HIV-infected patients admitted to hospital in Abidjan, Côte d'Ivoire, and to describe the level of immunosuppression at which these diseases occur.
Cross-sectional study.
In-patient wards of the University Hospital Infectious Diseases Unit.
A total of 250 adult patients recruited by systematic sampling at the point of hospital admission.
HIV status; CD4 count; diagnoses, confirmed by microbiological/radiological investigations whenever possible; and outcome of hospitalization (death or discharge).
Overall, 79% patients were HIV-positive. The most frequent diagnoses in HIV-positive patients were septicaemia (20%, with non-typhoid salmonellae, Escherichia coli and Streptococcus pneumoniae the most common organisms), HIV wasting (16%), meningitis (14%), tuberculosis (TB; 13%), isosporiasis (10%), cerebral toxoplasmosis (7%) and bacterial enteritis (7%). Most HIV-positive patients had evidence of severe immunosuppression: 39% had CD4 counts < 50 x 10(6)/l, 17% had 50-99 x 10(6)/l, and 20% had 100-199 x 10(6)/l. In-hospital mortality among HIV-positive patients was 38% compared with 27% among HIV-negative patients [age-adjusted odds ratio (OR), 1.5; 95% confidence interval (CI), 0.7-2.9]. Among HIV-positive patients, the highest case-fatality rates were among patients with meningitis, toxoplasmosis and TB: in a multivariate analysis the strongest independent risk factors for death were an abnormal level of consciousness (OR, 9.3; 95% CI, 3.5-24.6), a haemoglobin concentration below 8 g/dl (OR, 4.2; 95% CI, 1.4-12.8) and age > 40 years (OR, 3.9; 95% CI, 1.5-10.2).
Our data show that, as in industrialized countries, most HIV-infected individuals admitted to and dying in hospital in Abidjan are profoundly immunosuppressed. Potentially preventable infections are the main causes of in-hospital morbidity and mortality among HIV-infected persons in Abidjan, and the evaluation of appropriate primary prophylactic regimes is a priority.
描述在科特迪瓦阿比让住院的艾滋病毒感染患者中机会性疾病的种类，并描述这些疾病发生时的免疫抑制水平。
横断面研究。
大学医院传染病科住院病房。
通过在入院时系统抽样招募的250名成年患者。
艾滋病毒状况；CD4细胞计数；尽可能通过微生物学/放射学检查确诊的诊断结果；以及住院结局（死亡或出院）。
总体而言，79%的患者艾滋病毒呈阳性。艾滋病毒阳性患者中最常见的诊断是败血症（20%，非伤寒沙门氏菌、大肠杆菌和肺炎链球菌是最常见的病原体）、艾滋病毒消瘦症（16%）、脑膜炎（14%）、结核病（13%）、等孢球虫病（10%）、脑弓形虫病（7%）和细菌性肠炎（7%）。大多数艾滋病毒阳性患者有严重免疫抑制的证据：39%的患者CD4细胞计数<50×10⁶/L，17%的患者为50 - 99×10⁶/L，20%的患者为100 - 199×10⁶/L。艾滋病毒阳性患者的住院死亡率为38%，而艾滋病毒阴性患者为27%[年龄调整优势比（OR）为1.5；95%置信区间（CI）为0.7 - 2.9]。在艾滋病毒阳性患者中，脑膜炎、弓形虫病和结核病患者的病死率最高：在多变量分析中，死亡的最强独立危险因素是意识水平异常（OR为9.3；95%CI为3.5 - 24.6）、血红蛋白浓度低于8g/dl（OR为4.2；95%CI为1.4 - 12.8）和年龄>40岁（OR为3.9；95%CI为1.5 - 10.2）。
我们的数据表明，与工业化国家一样，在阿比让住院并死亡的大多数艾滋病毒感染者存在严重免疫抑制。潜在可预防的感染是阿比让艾滋病毒感染者住院发病率和死亡率的主要原因，评估适当的初级预防方案是当务之急。
