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ABSTRACT
Introduction. Despite global progress, HIV/AIDS remains a priority in West Africa. In Guinea, a previous study reported concerning hospital mortality. This study aimed to determine factors associated with morbidity and mortality among people living with HIV (PLHIV) hospitalized at the USFR-DONKA Ambulatory Treatment Center in Conakry. Methodology. We conducted a 4-year retrospective, descriptive, and analytical study (November 2016 - December 2020). We included patients aged at least 15 years, excluding deaths occurring within the first 48 hours. The USFR-DONKA ethics committee approved the protocol, and we collected data anonymously. Results. Out of 2236 records, 1861 patients (83.2%) were included. The mean age was 38.7 years and 61.5% were women. The majority (61.7%) presented at WHO stage IV. Tuberculosis co-infection was present in 70.3% of patients and undernutrition (BMI<16.5) in 61.7%. Severe immunosuppression (CD4 <200 cells/mm³) was noted in 82.1% and a detectable viral load in 89.6%. The overall mortality rate was 32.9% (n=613). In bivariate analysis, factors associated with death were hepatic failure (p<0.001), renal failure (p<0.001), and WHO stage IV (p<0.001). Conclusion. This study reveals a very high inpatient mortality among PLHIV in Conakry, primarily affecting young adult women. Severity at admission, illustrated by advanced stage, undernutrition, and co-infections, was the norm. These results underscore the critical need to strengthen early diagnosis and initiation of antiretroviral treatment before the stage of severe complications.
RÉSUMÉ
Introduction. Malgré les progrès mondiaux, le VIH/sida demeure une priorité en Afrique de l'Ouest. En Guinée, une étude antérieure rapportait une mortalité hospitalière préoccupante. Cette étude visait à déterminer les facteurs associés à la morbidité et à la mortalité chez les personnes vivant avec le VIH (PVVIH) hospitalisées au Centre de Traitement Ambulatoire de l'USFR-DONKA à Conakry. Méthodologie. Nous avons mené une étude rétrospective, descriptive et analytique sur 4 ans (novembre 2016 - décembre 2020). Nous avons inclus les patients âgés d’au moins 15 ans, à l'exception des décès survenus dans les 48 premières heures. Le comité d'éthique de l'USFR-DONKA a approuvé le protocole et nous avons collecté les données de manière anonyme. Résultats. Sur 2236 dossiers, 1861 patients (83,2%) ont été inclus. L'âge moyen était de 38,7 ans et 61,5% étaient des femmes. La majorité (61,7%) se présentait au stade IV de l'OMS. Une co-infection tuberculeuse était présente chez 70,3% des patients et une dénutrition (IMC<16,5) chez 61,7%. Une immunosuppression sévère (CD4 <200 cellules/mm³) était notée chez 82,1% et une charge virale détectable chez 89,6%. Le taux de mortalité globale était de 32,9% (n=613). En analyse bivariée, les facteurs associés au décès étaient une insuffisance hépatique (p<0,001), une insuffisance rénale (p<0,001) et le stade OMS IV (p<0,001). Conclusion. Cette étude révèle une mortalité hospitalière très élevée chez les PVVIH à Conakry, touchant principalement les jeunes adultes femmes. La gravité à l'admission, illustrée par le stade avancé, la dénutrition et les co-infections, est la règle. Ces résultats soulignent l'impérieuse nécessité de renforcer le dépistage précoce et la mise sous traitement antirétroviral avant le stade de complications sévères.
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References
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- 7. Chelli J, Bellazreg F, Aouem A, Hattab Z, Mesmia H, Lasfar NB, et al. Causes of death among HIV-infected patients in Central Tunisia. Pan Afr Med J 2016;25. https://doi.org/10.11604/pamj.2016.25.105.9748.
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- 9. Sodqi M, Marih L, Lahsen AO, Bensghir R, Chakib A, Himmich H, et al. Causes of death in 91 patients with HIV infection treated with antiretrovirals. Presse Médicale 2012;41:e386–90. https://doi.org/10.1016/j.lpm.2011.12.013.
- 10. Konate I, Kabore M, Cissoko Y, Soumaré M, Dembélé JP, Sidibé A, et al. Risk Factors of Mortality in HIV-Infected Patients Hospitalized and Treated for Tuberculosis at the University Hospital Center of Point “G”, Mali. Health Sci Dis 2019;20:10–7. https://doi.org/10.5281/hsd.v20i1.1330.
- 11. Fortes Déguénonvo L, Manga NM, Diop SA, Dia Badiane NM, Seydi M, Ndour CT, et al. Current profile of HIV-infected patients hospitalized in Dakar (Senegal). Bull Société Pathol Exot 2011;104:366–70. https://doi.org/10.1007/s13149-011-0178-9.
- 12. Dokekias AE, Galiba FOA, Bokilo ADL, Ntsimba P, Nsitou MB, Malanda F, et al. Evaluation of antiretroviral therapy in HIV-infected adults in the Department of Haematology, University Hospital of Brazzaville, Congo. Bull Soc Pathol Exot 1990 2008;101:109–12.
- 13. Kaba ML, Condé A, Soumah M, Cissé M, Traoré M, Diakité F, et al. Prevalence of acute and chronic renal failure in HIV-infected patients in Conakry. Néphrologie Thérapeutique 2016;12:408–9. https://doi.org/10.1016/j.nephro.2016.07.134.
- 14. Guei MC, Sidibé M, Wognin A, Konan SD, Choho MC, Yao HK, et al. Outcome of acute renal failure in subjects with HIV living in Abidjan, Ivory Coast over the period 1st January 2014 to 31st December 2017. Pan Afr Med J 2019;34:2. https://doi.org/10.11604/pamj.2019.34.2.20016.
- 15. Ondounda M, Magne C, Mounguengui D, Gaudong Mbethe L, Nzenze JR. Morbidity and mortality in HIV-infected patients in the Military Hospital in Libreville (Gabon). Med Sante Trop 2012;22:334–5. https://doi.org/10.1684/mst.2012.0093.
References
1. Ghoma Linguissi LS, Lucaccioni V, Bates M, Zumla A, Ntoumi F. Achieving sustainable development goals for HIV/AIDS in the Republic of the Congo, Progress, obstacles and challenges in HIV/AIDS health services. Int J Infect Dis 2018; 77:107–12. https://doi.org/10.1016/j.ijid.2018.10.009.
2. GBD 2017 HIV collaborators. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. Lancet HIV 2019;6:e831–59. https://doi.org/10.1016/S2352-3018(19)30196-1.
3. Mouhari-Touré A, Mahamadou G, Kombate K, Akakpo AS, Teclessou JN, Singo A, et al. Morbidity and mortality in HIV-infected children on antiretroviral therapy in Togo. Med Sante Trop 2018; 28:54–60. https://doi.org/10.1684/mst.2018.0767.
4. Traoré FA, Baldé H, Diallo FD, Sako FB, Camara AD, Keïta M, et al. assessment of 5 years of hiv infection management in a decentralized site: case of the boké regional hospital. Guinée Médicale 2015:9–17.
5. Mongo-Delis A, Mickala P, Mombo LE, Bouedy WS, Mengue J-CE, Itsonoganga GL, et al. Factors influencing loss to follow-up and mortality in people living with HIV.at the Koula-Moutou Outpatient Treatment Centre (Gabon) from 2005 to 2015. Pan Afr Med J 2016;24:1–10. https://doi.org/10.11604/pamj.2016.24.198.9708.
6. Ouedraogo SM, Zoungrana J, Sondo KA, Kyelem CG, Koussé S, Hema A, et al. Immuno-virological dissociation in HIV-1 infected patients undergoing antiretroviral treatment at the Bobo-Dioulasso Day Hospital from 2008 to 2012 (Burkina Faso). Mali Med 2015.
7. Chelli J, Bellazreg F, Aouem A, Hattab Z, Mesmia H, Lasfar NB, et al. Causes of death among HIV-infected patients in Central Tunisia. Pan Afr Med J 2016;25. https://doi.org/10.11604/pamj.2016.25.105.9748.
8. Cissé M, Sako FB, Diaby B, Soumah MM, Tounkara TM, Diane BF, et al. Evaluation of antiretroviral treatment in HIV infected adults in the department of dermatology venereology of the Donka national hospital. Mali Med 2015;30:16–20.
9. Sodqi M, Marih L, Lahsen AO, Bensghir R, Chakib A, Himmich H, et al. Causes of death in 91 patients with HIV infection treated with antiretrovirals. Presse Médicale 2012;41:e386–90. https://doi.org/10.1016/j.lpm.2011.12.013.
10. Konate I, Kabore M, Cissoko Y, Soumaré M, Dembélé JP, Sidibé A, et al. Risk Factors of Mortality in HIV-Infected Patients Hospitalized and Treated for Tuberculosis at the University Hospital Center of Point “G”, Mali. Health Sci Dis 2019;20:10–7. https://doi.org/10.5281/hsd.v20i1.1330.
11. Fortes Déguénonvo L, Manga NM, Diop SA, Dia Badiane NM, Seydi M, Ndour CT, et al. Current profile of HIV-infected patients hospitalized in Dakar (Senegal). Bull Société Pathol Exot 2011;104:366–70. https://doi.org/10.1007/s13149-011-0178-9.
12. Dokekias AE, Galiba FOA, Bokilo ADL, Ntsimba P, Nsitou MB, Malanda F, et al. Evaluation of antiretroviral therapy in HIV-infected adults in the Department of Haematology, University Hospital of Brazzaville, Congo. Bull Soc Pathol Exot 1990 2008;101:109–12.
13. Kaba ML, Condé A, Soumah M, Cissé M, Traoré M, Diakité F, et al. Prevalence of acute and chronic renal failure in HIV-infected patients in Conakry. Néphrologie Thérapeutique 2016;12:408–9. https://doi.org/10.1016/j.nephro.2016.07.134.
14. Guei MC, Sidibé M, Wognin A, Konan SD, Choho MC, Yao HK, et al. Outcome of acute renal failure in subjects with HIV living in Abidjan, Ivory Coast over the period 1st January 2014 to 31st December 2017. Pan Afr Med J 2019;34:2. https://doi.org/10.11604/pamj.2019.34.2.20016.
15. Ondounda M, Magne C, Mounguengui D, Gaudong Mbethe L, Nzenze JR. Morbidity and mortality in HIV-infected patients in the Military Hospital in Libreville (Gabon). Med Sante Trop 2012;22:334–5. https://doi.org/10.1684/mst.2012.0093.