title: Severe morbidity after antiretroviral (ART) initiation: active surveillance in HIV care programs, the IeDEA West Africa collaboration.
abstract: BACKGROUND
  The causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes are poorly documented in sub-Saharan Africa. We aimed to describe severe morbidity among HIV-infected patients after ART initiation, based on data from an active surveillance system established within a network of specialized care facilities in West African cities.
  
  
  METHODS
  Within the International epidemiological Database to Evaluate AIDS (IeDEA)--West Africa collaboration, we conducted a prospective, multicenter data collection that involved two facilities in Abidjan, Côte d'Ivoire and one in Cotonou, Benin. Among HIV-infected adults receiving ART, events were recorded using a standardized form. A simple case-definition of severe morbidity (death, hospitalization, fever>38°5C, Karnofsky index<70%) was used at any patient contact point. Then a physician confirmed and classified the event as WHO stage 3 or 4 according to the WHO clinical classification or as degree 3 or 4 of the ANRS scale.
  
  
  RESULTS
  From December 2009 to December 2011, 978 adults (71% women, median age 39 years) presented with 1449 severe events. The main diagnoses were: non-AIDS-defining infections (33%), AIDS-defining illnesses (33%), suspected adverse drug reactions (7%), other illnesses (4%) and syndromic diagnoses (16%). The most common specific diagnoses were: malaria (25%), pneumonia (13%) and tuberculosis (8%). The diagnoses were reported as syndromic in one out of five events recorded during this study.
  
  
  CONCLUSIONS
  This study highlights the ongoing importance of conventional infectious diseases among severe morbid events occurring in patients on ART in ambulatory HIV care facilities in West Africa. Meanwhile, additional studies are needed due to the undiagnosed aspect of severe morbidity in substantial proportion.
authors.affiliation: Programme PAC-CI, Centre Hospitalier Universitaire (CHU) de Treichville, 18 BP 1954, Abidjan 18, Côte d'Ivoire. aysonabo@gmail.com.|Centre Médical de Suivi des Donneurs de Sang (CMSDS), Centre National de Transfusion Sanguine, Abidjan, Côte d'Ivoire. aysonabo@gmail.com.
authors.forename: Yao
authors.initials: Y
authors.lastname: Abo
authors.affiliation: Centre de Traitement Ambulatoire (CTA), Centre National Hospitalier Universitaire (CNHU), Cotonou, Benin. djmzannou@yahoo.fr.|Université d'Abomey-Calavi, Cotonou, Bénin. djmzannou@yahoo.fr.
authors.forename: Marcel
authors.initials: M
authors.lastname: Zannou Djimon
authors.affiliation: University Bordeaux, ISPED, Bordeaux, France. messou_eugene@yahoo.fr.|Centre de Prise en charge de Recherche et de Formation (Aconda-CePReF), Abidjan, Côte d'Ivoire. messou_eugene@yahoo.fr.
authors.forename: Eugène
authors.initials: E
authors.lastname: Messou
authors.affiliation: INSERM, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France. Eric.Balestre@isped.u-bordeaux2.fr.|University Bordeaux, ISPED, Bordeaux, France. Eric.Balestre@isped.u-bordeaux2.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Balestre
authors.affiliation: Centre de Prise en charge de Recherche et de Formation (Aconda-CePReF), Abidjan, Côte d'Ivoire. martchelo_ci@yahoo.fr.
authors.forename: Martial
authors.initials: M
authors.lastname: Kouakou
authors.affiliation: Centre de Traitement Ambulatoire (CTA), Centre National Hospitalier Universitaire (CNHU), Cotonou, Benin. jocen12@yahoo.fr.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Akakpo
authors.affiliation: Centre de Traitement Ambulatoire (CTA), Centre National Hospitalier Universitaire (CNHU), Cotonou, Benin. ahouada@yahoo.fr.
authors.forename: Carin
authors.initials: C
authors.lastname: Ahouada
authors.affiliation: INSERM, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France. Nathalie.De-Rekeneire@isped.u-bordeaux2.fr.|University Bordeaux, ISPED, Bordeaux, France. Nathalie.De-Rekeneire@isped.u-bordeaux2.fr.
authors.forename: Nathalie
authors.initials: N
authors.lastname: de Rekeneire
authors.affiliation: INSERM, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France. Francois.Dabis@isped.u-bordeaux2.fr.|University Bordeaux, ISPED, Bordeaux, France. Francois.Dabis@isped.u-bordeaux2.fr.
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.affiliation: INSERM, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France. Charlotte.lewden@riseup.net.|University Bordeaux, ISPED, Bordeaux, France. Charlotte.lewden@riseup.net.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lewden
authors.affiliation: Programme PAC-CI, Centre Hospitalier Universitaire (CHU) de Treichville, 18 BP 1954, Abidjan 18, Côte d'Ivoire. minga.albert@yahoo.fr.|Centre Médical de Suivi des Donneurs de Sang (CMSDS), Centre National de Transfusion Sanguine, Abidjan, Côte d'Ivoire. minga.albert@yahoo.fr.
authors.forename: Albert
authors.initials: A
authors.lastname: Minga
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001541:Benin / Q000453:epidemiology; D003299:Cooperative Behavior; D007560:Cote d'Ivoire / Q000453:epidemiology; D003625:Data Collection; D016208:Databases, Factual; D005260:Female; D005334:Fever / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017567:Karnofsky Performance Status; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011014:Pneumonia / Q000453:epidemiology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014376:Tuberculosis / Q000453:epidemiology*
chemical_list: D019380:Anti-HIV Agents