title: Incidence of serious morbidity in HIV-infected adults on antiretroviral therapy in a West African care centre, 2003-2008.
abstract: BACKGROUND
  In resource-limited settings, scaling-up antiretroviral treatment (ART) has required the involvement of decentralized health facilities with limited equipment. We estimated the incidence of serious morbidity among HIV-infected adults receiving ART in one of these HIV routine care center in sub-Saharan Africa.
  
  
  METHODS
  We conducted a prospective study at the Centre Medical de Suivi des Donneurs de Sang (CMSDS), which is affiliated with the National Centre for Blood Transfusion in Abidjan, Côte d'Ivoire. Adult patients infected with HIV-1 or HIV-1/HIV-2 who initiated ART between January 2003 and December 2008 were eligible for the study. Standardized clinical data were collected at each visit. Serious morbidity was defined as a new episode of malaria, WHO stage 3-4 event, ANRS grade 3-4 adverse event, or any event leading to death or to hospitalization.
  
  
  RESULTS
  1008 adults, 67% women, with a median age of 35 years, and a median pre-ART CD4 count of 186/mm3 started ART and were followed for a median of 17.3 months. The overall incidences of loss to follow-up, death, and attrition were 6.2/100 person-years (PY) [95% CI 5.1-7.2], 2.3/100 PY [95% CI 1.6-2.9], and 8.1/100 PY [95% CI 7.0-9.4], respectively. The incidence of first serious event was 11.5/100 PY overall, 15.9/100 PY within the first year and 8.3/100 PY thereafter. The most frequently documented specific diagnoses were malaria, tuberculosis, bacterial septicemia and bacterial pneumonia.
  
  
  CONCLUSIONS
  Among HIV-infected adults followed in routine conditions in a West African primary care clinic, we recorded a high incidence of serious morbidity during the first year on ART. Providing care centers with diagnostic tools and standardizing data collection are necessary steps to improve the quality of care in primary care facilities in sub-Saharan Africa.
authors.affiliation: Programme PAC-CI, Centre Hospitalier Universitaire (CHU) de Treichville, 18 BP 1954, Abidjan, Côte d'Ivoire. aysonabo@gmail.com.
authors.forename: Yao
authors.initials: Y
authors.lastname: Abo
authors.forename: Albert
authors.initials: A
authors.lastname: Minga
authors.forename: Hervé
authors.initials: H
authors.lastname: Menan
authors.forename: Christine
authors.initials: C
authors.lastname: Danel
authors.forename: Timothée
authors.initials: T
authors.lastname: Ouassa
authors.forename: Lambert
authors.initials: L
authors.lastname: Dohoun
authors.forename: Germain
authors.initials: G
authors.lastname: Bomisso
authors.forename: Anthony
authors.initials: A
authors.lastname: Tanoh
authors.forename: Eugène
authors.initials: E
authors.lastname: Messou
authors.forename: Serge
authors.initials: S
authors.lastname: Eholié
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lewden
authors.forename: Xavier
authors.initials: X
authors.lastname: Anglaret
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003151:Community Health Centers / Q000706:statistics & numerical data; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents