title: Profound immunosuppression across the spectrum of opportunistic disease among hospitalized HIV-infected adults in Abidjan, Côte d'Ivoire.
abstract: 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.
authors.affiliation: Project RETRO-CL, London School of Hygiene and Tropical Medicine, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Grant
authors.forename: G
authors.initials: G
authors.lastname: Djomand
authors.forename: P
authors.initials: P
authors.lastname: Smets
authors.forename: A
authors.initials: A
authors.lastname: Kadio
authors.forename: M
authors.initials: M
authors.lastname: Coulibaly
authors.forename: A
authors.initials: A
authors.lastname: Kakou
authors.forename: C
authors.initials: C
authors.lastname: Maurice
authors.forename: J P
authors.initials: JP
authors.lastname: Whitaker
authors.forename: F
authors.initials: F
authors.lastname: Sylla-Koko
authors.forename: D
authors.initials: D
authors.lastname: Bonard
authors.forename: S Z
authors.initials: SZ
authors.lastname: Wiktor
authors.forename: R J
authors.initials: RJ
authors.lastname: Hayes
authors.forename: K M
authors.initials: KM
authors.lastname: De Cock
authors.forename: A E
authors.initials: AE
authors.lastname: Greenberg
mesh_terms: 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
chemical_list: D006454:Hemoglobins