Grant A D, Sidibé K, Domoua K, Bonard D, Sylla-Koko F, Dosso M, Yapi A, Maurice C, Whitaker J P, Lucas S B, Hayes R J, Wiktor S Z, De Cock K M, Greenberg A E
Project RETRO-CI, Abidjan, Côte d'Ivoire.
Int J Tuberc Lung Dis. 1998 Nov;2(11):926-34.
Respiratory medicine wards of the University Teaching Hospital, Abidjan, Côte d'Ivoire.
To describe the spectrum of opportunistic infection among human immunodeficiency virus (HIV) infected adults hospitalised in the respiratory medicine unit in Abidjan, and the level of immunosuppression at which these diseases occur.
Cross-sectional study.
Overall, 75% of patients were HIV-positive: among these patients, the most frequent diagnosis was tuberculosis, in 61%, followed by bacterial pneumonia (15%), Gram-negative septicaemia (particularly non-typhoid Salmonella) (9%) and empyema (5%). Atypical pneumonias appeared to be rare. Most HIV-positive patients had CD4 counts indicative of advanced immunosuppression: 36% had CD4 counts below 100 x 10(6)/l, 19% between 100 and 199 x 10(6)/l, 29% between 200 and 499 x 10(6)/l, and 16% above 500 x 10(6)/l. Overall in-hospital mortality was 27% for HIV-positive patients and 22% for HIV-negative patients (P = 0.5). In a multivariate analysis, the strongest independent risk factors for death were cachexia (odds ratio [OR] 7.4, 95% confidence interval [CI] 2.1-26.3), male sex (OR 4.5, 95% CI 1.2-17.4) and age over 40 (OR 4.1, 95% CI 1.0-17.2).
Tuberculosis and bacterial infections are the major causes of respiratory morbidity in immunosuppressed HIV-infected adults in this population. Efforts to improve the management of HIV-related disease need to focus on prevention and treatment of these infections.
科特迪瓦阿比让大学教学医院呼吸内科病房。
描述阿比让呼吸内科病房住院的人类免疫缺陷病毒（HIV）感染成人中机会性感染的范围，以及这些疾病发生时的免疫抑制水平。
横断面研究。
总体而言，75%的患者HIV呈阳性：在这些患者中，最常见的诊断是结核病，占61%，其次是细菌性肺炎（15%）、革兰氏阴性败血症（特别是非伤寒沙门氏菌）（9%）和脓胸（5%）。非典型肺炎似乎很少见。大多数HIV阳性患者的CD4计数表明存在严重免疫抑制：36%的患者CD4计数低于100×10⁶/L，19%在100至199×10⁶/L之间，29%在200至499×10⁶/L之间，16%高于500×10⁶/L。总体而言，HIV阳性患者的院内死亡率为27%；HIV阴性患者为22%（P = 0.5）。在多变量分析中，最强的独立死亡危险因素是恶病质（比值比[OR]7.4，95%置信区间[CI]2.1 - 26.3）、男性（OR 4.5，95% CI 1.2 - 17.4）和年龄超过40岁（OR 4.1，95% CI 1.0 - 17.2）。
结核病和细菌感染是该人群中免疫抑制的HIV感染成人呼吸疾病的主要原因。改善HIV相关疾病管理的努力需要集中在这些感染的预防和治疗上。
