title: The mortality and pathology of HIV infection in a west African city.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Projet RETRO-CI, Abidjan, Côte d'Ivoire.
authors.forename: S B
authors.initials: SB
authors.lastname: Lucas
authors.forename: A
authors.initials: A
authors.lastname: Hounnou
authors.forename: C
authors.initials: C
authors.lastname: Peacock
authors.forename: A
authors.initials: A
authors.lastname: Beaumel
authors.forename: G
authors.initials: G
authors.lastname: Djomand
authors.forename: J M
authors.initials: JM
authors.lastname: N'Gbichi
authors.forename: K
authors.initials: K
authors.lastname: Yeboue
authors.forename: M
authors.initials: M
authors.lastname: Hondé
authors.forename: M
authors.initials: M
authors.lastname: Diomande
authors.forename: C
authors.initials: C
authors.lastname: Giordano
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000209:etiology / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000354:Africa, Western; D001424:Bacterial Infections / Q000150:complications; D001921:Brain / Q000473:pathology; D015496:CD4-Positive T-Lymphocytes; D002493:Central Nervous System Diseases / Q000209:etiology / Q000473:pathology; D004660:Encephalitis / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000401:mortality* / Q000473:pathology*; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D016781:Toxoplasmosis, Cerebral / Q000209:etiology; D014376:Tuberculosis / Q000150:complications / Q000473:pathology