Profound immunosuppression across the spectrum of opportunistic disease among hospitalized HIV-infected adults in Abidjan, Côte d'Ivoire.
OBJECTIVE
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.


METHODS
Cross-sectional study.


METHODS
In-patient wards of the University Hospital Infectious Diseases Unit.


METHODS
A total of 250 adult patients recruited by systematic sampling at the point of hospital admission.


METHODS
HIV status; CD4 count; diagnoses, confirmed by microbiological/radiological investigations whenever possible; and outcome of hospitalization (death or discharge).


RESULTS
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).


CONCLUSIONS
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.
Grant
A D
AD
Project RETRO-CL, London School of Hygiene and Tropical Medicine, UK.
Djomand
G
G
Smets
P
P
Kadio
A
A
Coulibaly
M
M
Kakou
A
A
Maurice
C
C
Whitaker
J P
JP
Sylla-Koko
F
F
Bonard
D
D
Wiktor
S Z
SZ
Hayes
R J
RJ
De Cock
K M
KM
Greenberg
A E
AE
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis; D018791:CD4 Lymphocyte Count; D007560:Cote d'Ivoire / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004751:Enteritis / Q000175:diagnosis / Q000382:microbiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology* / Q000401:mortality; D019247:HIV Wasting Syndrome / Q000175:diagnosis; D015497:HIV-1; D015498:HIV-2; D006454:Hemoglobins / Q000032:analysis; D006760:Hospitalization; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008581:Meningitis / Q000175:diagnosis; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D014123:Toxoplasmosis / Q000175:diagnosis; D014376:Tuberculosis / Q000175:diagnosis
D006454:Hemoglobins