Spectrum of disease among HIV-infected adults hospitalised in a respiratory medicine unit in Abidjan, Côte d'Ivoire
Abstract:SETTING: Respiratory medicine wards of the University Teaching Hospital, Abidjan, Côte d'Ivoire.
OBJECTIVES: To describe the spectrum of opportunistic infection among human immunodeficiency virus (HIV) infected adults hospitalised in the respiratory medicine unit in Abidjan, and the level of immunosuppression at which these diseases occur.
DESIGN: Cross-sectional study.
RESULTS: Overall, 75% of patients were HIV-positive: among these patients, the most frequent diagnosis was tuberculosis, in 61%, followed by bacterial pneumonia (15%), Gram-negative septicaemia (particularly non-typhoid Salmonella) (9%) and empyema (5%). Atypical pneumonias appeared to be rare. Most HIV-positive patients had CD4 counts indicative of advanced immunosuppression: 36% had CD4 counts below 100 × 106/l, 19% between 100 and 199 × 106/l, 29% between 200 and 499 × 106/l, and 16% above 500 × 106/l. Overall in-hospital mortality was 27% for HIV-positive patients and 22% for HIV-negative patients (P = 0.5). In a multivariate analysis, the strongest independent risk factors for death were cachexia (odds ratio [OR] 7.4, 95% confidence interval [CI] 2.1–26.3), male sex (OR 4.5, 95% CI 1.2–17.4) and age over 40 (OR 4.1, 95% CI 1.0–17.2).
CONCLUSIONS: Tuberculosis and bacterial infections are the major causes of respiratory morbidity in immunosuppressed HIV-infected adults in this population. Efforts to improve the management of HIV-related disease need to focus on prevention and treatment of these infections.
Document Type: Regular Paper
Affiliations: 1: Projet RETRO-CI, Abidjan, Côte d'Ivoire, UK; and London School of Hygiene and Tropical Medicine, London, UK 2: Projet RETRO-CI, Abidjan, Côte d'Ivoire, UK 3: Service de Pneumophtisiologie et Centre de Diagnostic et de Recherche sur le SIDA, CHU de Treichville, Abidjan, Côte d'Ivoire, UK 4: Centre de Diagnostic et de Recherche sur le SIDA, CHU de Treichville, Abidjan, Côte d'Ivoire, UK 5: Institut Pasteur, Abidjan, Côte d'Ivoire, UK 6: Projet RETRO-CI, Abidjan, Côte d'Ivoire, UK; and Division of HIV/AIDS Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 7: United Medical and Dental School, Department of Histopathology, St Thomas' Hospital, London, UK 8: London School of Hygiene and Tropical Medicine, London, UK 9: London School of Hygiene and Tropical Medicine, London, UK; and Division of HIV/AIDS Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Publication date: November 1, 1998
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