Disease patterns and causes of death of hospitalized HIV-positive adults in West Africa: a multicountry survey in the antiretroviral treatment era
Disease patterns and causes of death of hospitalized HIV-positive adults in West Africa: a multicountry survey in the antiretroviral treatment era
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DOI：
10.7448/ias.17.1.18797
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发表时间：
2014-04-07
影响因子：
6
通讯作者：
Eholie, Serge P.
中科院分区：
文献类型：
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作者：
Lewden, Charlotte;Drabo, Youssoufou J.;Eholie, Serge P.
目的：我们的目的是描述艾滋病毒阳性的成年人在西非住院的发病率和死亡率的模式。方法：我们进行了为期6个月的前瞻性多中心调查内的ieDEA西非合作，在阿比让，瓦加杜古，科托努，达喀尔和巴马科的教学医院的6个成人病房。2010年4月至10月，所有新住院的艾滋病毒阳性患者都符合资格。使用标准化表格记录基线和出院前的随访信息。由当地事件验证委员会使用参考定义对诊断进行审查。结果：在823例住院的HIV阳性成人（中位年龄40岁，58%为女性）中，24%在住院期间发现HIV感染，中位CD 4计数为75/mm 3（IQR：25-177），48%既往接受过抗逆转录病毒治疗（ART）。住院的根本原因是艾滋病定义的疾病（54%）、其他感染（32%）、其他疾病（8%）和非特异性疾病（6%）。最常见的疾病是：肺结核（29%）、肺炎（15%）、疟疾（10%）和脑弓形虫病（10%）。总体而言，315例（38%）患者在住院期间死亡，潜在死亡原因为艾滋病（63%）、非艾滋病定义感染（26%）、其他疾病（7%）和非特异性疾病或不明原因（4%）。其中，最常见的致命疾病是：结核病（36%）、脑弓形虫病（10%）、隐球菌病（9%）和败血症（7%）。年龄较大，临床WHO阶段3和4，低CD 4计数，艾滋病定义的感染性诊断与医院fatality.Conclusions：艾滋病定义的条件，主要是结核病，细菌感染是最常见的原因住院治疗的HIV阳性的成年人在西非，并导致高住院病死率。需要持续努力，以整合这些疾病的护理，并优化艾滋病毒感染的早期诊断和抗逆转录病毒治疗的启动。
Objective: We aimed to describe the morbidity and mortality patterns in HIV-positive adults hospitalized in West Africa.Method: 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.