Disease patterns and causes of death of hospitalized HIV-positive adults in West Africa: a multicountry survey in the antiretroviral treatment era.
OBJECTIVE
We aimed to describe the morbidity and mortality patterns in HIV-positive adults hospitalized in West Africa.


METHODS
We conducted a six-month prospective multicentre survey within the IeDEA West Africa collaboration in six adult medical wards of teaching hospitals in Abidjan, Ouagadougou, Cotonou, Dakar and Bamako. From April to October 2010, all newly hospitalized HIV-positive patients were eligible. Baseline and follow-up information until hospital discharge was recorded using standardized forms. Diagnoses were reviewed by a local event validation committee using reference definitions. Factors associated with in-hospital mortality were studied with a logistic regression model.


RESULTS
Among 823 hospitalized HIV-positive adults (median age 40 years, 58% women), 24% discovered their HIV infection during the hospitalization, median CD4 count was 75/mm(3) (IQR: 25-177) and 48% had previously received antiretroviral treatment (ART). The underlying causes of hospitalization were AIDS-defining conditions (54%), other infections (32%), other diseases (8%) and non-specific illness (6%). The most frequent diseases diagnosed were: tuberculosis (29%), pneumonia (15%), malaria (10%) and cerebral toxoplasmosis (10%). Overall, 315 (38%) patients died during hospitalization and the underlying cause of death was AIDS (63%), non-AIDS-defining infections (26%), other diseases (7%) and non-specific illness or unknown cause (4%). Among them, the most frequent fatal diseases were: tuberculosis (36%), cerebral toxoplasmosis (10%), cryptococcosis (9%) and sepsis (7%). Older age, clinical WHO stage 3 and 4, low CD4 count, and AIDS-defining infectious diagnoses were associated with hospital fatality.


CONCLUSIONS
AIDS-defining conditions, primarily tuberculosis, and bacterial infections were the most frequent causes of hospitalization in HIV-positive adults in West Africa and resulted in high in-hospital fatality. Sustained efforts are needed to integrate care of these disease conditions and optimize earlier diagnosis of HIV infection and initiation of ART.
Université de Bordeaux, ISPED, Centre INSERM U897, Bordeaux, France; INSERM, Centre INSERM U897, Bordeaux, France; charlotte.lewden@isped.u-bordeaux2.fr.
Charlotte
C
Lewden
Department of Internal Medicine, University Hospital Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
Youssoufou J
YJ
Drabo
Centre National Hospitalier et Universitaire Hubert Koutoukou Maga, Service de Médecine Interne, Cotonou, Benin.
Djimon M
DM
Zannou
Hôpital Gabriel-Touré, Service d'Hépatogastroentérologie, Bamako, Mali.
Moussa Y
MY
Maiga
Hôpital du point G, Service de maladies infectieuses, Bamako, Mali.
Daouda K
DK
Minta
Department of Infectious Diseases, Fann University Hospital, Dakar, Senegal.
Papa S
PS
Sow
Centre National Hospitalier et Universitaire Hubert Koutoukou Maga, Service de Médecine Interne, Cotonou, Benin.
Jocelyn
J
Akakpo
Université de Bordeaux, ISPED, Centre INSERM U897, Bordeaux, France; INSERM, Centre INSERM U897, Bordeaux, France.
François
F
Dabis
Department of Infectious Diseases, Treichville University Hospital, Abidjan, Côte d'Ivoire.
Serge P
SP
Eholié
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged
D019380:Anti-HIV Agents
AIDS; Africa; HIV infection; antiretroviral therapy; hospitalization; morbidity