Suchergebnisse

ObjectiveWe aimed to describe the morbidity and mortality patterns in HIV‐positive adults hospitalized in West Africa.MethodWe 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.ResultsAmong 823 hospitalized HIV‐positive adults (median age 40 years, 58% women), 24% discovered their HIV infection during the hospitalization, median CD4 count was 75/mm3 (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.ConclusionsAIDS‐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.

IntroductionCurrent knowledge on morbidity and mortality in HIV‐infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV‐infected children in West Africa (IeDEA West Africa collaboration).MethodsWe performed a six‐month prospective multicentre survey from April to October 2010 in five HIV‐specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow‐up data during hospitalization were recorded using a standardized clinical form, and extracted from hospitalization files and local databases. Event validation committees reviewed diagnoses within each centre. HIV‐related events were defined according to the WHO definitions.ResultsFrom April to October 2010, 155 HIV‐infected children were hospitalized; median age was 3 years [1–8]. Among them, 90 (58%) were confirmed for HIV infection during their stay; 138 (89%) were already receiving cotrimoxazole prophylaxis and 64 children (40%) had initiated antiretroviral therapy (ART). The median length of stay was 13 days (IQR: 7–23); 25 children (16%) died during hospitalization and four (3%) were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%), non‐AIDS‐defining events (28%), cachexia and other WHO stage 4 events (25%).ConclusionsOverall, most causes of hospitalizations were HIV related but one hospitalization in three was caused by a non‐AIDS‐defining event, mostly in children on ART. HIV‐related fatality is also high despite the scaling‐up of access to ART in resource‐limited settings.