Severe morbidity after antiretroviral (ART) initiation: active surveillance in HIV care programs, the IeDEA West Africa collaboration

BMC Infectious Diseases

Albert Minga³  Charlotte Lewden⁴  François Dabis⁴  Nathalie de Rekeneire⁴  Carin Ahouada²  Jocelyn Akakpo²  Martial Kouakou⁵  Eric Balestre⁴  Eugène Messou⁵  Marcel Zannou Djimon¹  Yao Abo³ 

[1]Université d’Abomey-Calavi, Cotonou, Bénin

[2]Centre de Traitement Ambulatoire (CTA), Centre National Hospitalier Universitaire (CNHU), Cotonou, Benin

[3]Centre Médical de Suivi des Donneurs de Sang (CMSDS), Centre National de Transfusion Sanguine, Abidjan, Côte d’Ivoire

[4]University Bordeaux, ISPED, Bordeaux, France

[5]Centre de Prise en charge de Recherche et de Formation (Aconda-CePReF), Abidjan, Côte d’Ivoire

关键词: West Africa;    Ambulatory HIV care facilities;    Severe morbidity;    Antiretroviral therapy;   

Others  :  1173911
DOI  :  10.1186/s12879-015-0910-3

 received in 2014-07-31, accepted in 2015-03-18,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 Abo et al.; licensee BioMed Central.

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