Abstract
BackgroundThe 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.MethodsWithin 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.ResultsFrom 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.ConclusionsThis 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0910-3) contains supplementary material, which is available to authorized users.
Highlights
The causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes are poorly documented in sub-Saharan Africa
The objective of our study was, to describe severe morbidity occurring among Human Immunodeficiency Virus (HIV)-infected adult patients, receiving ART based on surveillance data collected prospectively under routine circumstances in HIV/Acquired Immuno Deficiency Syndrome (AIDS) care facilities in Sub-Saharan Africa (SSA)
Between December 2009 and December 2011, 978 HIVinfected adults followed up in three facilities of the International epidemiological Database to Evaluate AIDS (IeDEA) West Africa collaboration and presenting at least with one severe event were included in this study
Summary
The causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes are poorly documented in sub-Saharan Africa. Despite the rapid increase in availability of antiretroviral drugs in SSA since [2], mortality and morbidity associated with HIV remain high among patients starting ART [3,4]. This high frequency of Acquired Immuno Deficiency Syndrome (AIDS)related morbidity is due to late diagnosis of HIV infection and leading to a late initiation of treatment [5]. Among SSA hospitalized HIV-positive patients, the most frequent causes of hospitalization are AIDS-defining conditions, tuberculosis
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