%0 Journal Article %1 grant_profound_1997 %A Grant, A D %A Djomand, G %A Smets, P %A Kadio, A %A Coulibaly, M %A Kakou, A %A Maurice, C %A Whitaker, J P %A Sylla-Koko, F %A Bonard, D %A Wiktor, S Z %A Hayes, R J %A Cock, K M De %A Greenberg, A E %D 1997 %J AIDS (London, England) %K Adolescent, Adult, Age Aged, Analysis, Bacterial Cote Count, Enteritis, Factors, Female, Hemoglobins, Hospitalization, Humans, Immunosuppression, Infections, Lymphocyte Male, Meningitis, Middle Multivariate Opportunistic Risk Studies, Syndrome, Toxoplasmosis, Tuberculosis Wasting {AIDS-Related} {CD4} {Cross-Sectional} {HIV-1,} {HIV-2,} {HIV} {d'Ivoire,} %N 11 %P 1357--64 %T Profound immunosuppression across the spectrum of opportunistic disease among hospitalized HIV-infected adults in Abidjan, Côte d'Ivoire %U http://www.ncbi.nlm.nih.gov/pubmed/9302446 %V 11 %X OBJECTIVES: To describe the spectrum of opportunistic disease in HIV-infected patients admitted to hospital in Abidjan, Côte d'Ivoire, and to describe the level of immunosuppression at which these diseases occur. DESIGN: Cross-sectional study. SETTING: In-patient wards of the University Hospital Infectious Diseases Unit. PATIENTS: A total of 250 adult patients recruited by systematic sampling at the point of hospital admission. MAIN MEASURES: HIV status; CD4 count; diagnoses, confirmed by microbiological/radiological investigations whenever possible; and outcome of hospitalization (death or discharge). RESULTS: Overall, 79\% patients were HIV-positive. The most frequent diagnoses in HIV-positive patients were septicaemia (20\%, with non-typhoid salmonellae, Escherichia coli and Streptococcus pneumoniae the most common organisms), HIV wasting (16\%), meningitis (14\%), tuberculosis (TB; 13\%), isosporiasis (10\%), cerebral toxoplasmosis (7\%) and bacterial enteritis (7\%). Most HIV-positive patients had evidence of severe immunosuppression: 39\% had CD4 counts \textless 50 x 10(6)/l, 17\% had 50-99 x 10(6)/l, and 20\% had 100-199 x 10(6)/l. In-hospital mortality among HIV-positive patients was 38\% compared with 27\% among HIV-negative patients age-adjusted odds ratio (OR), 1.5; 95\% confidence interval (CI), 0.7-2.9. Among HIV-positive patients, the highest case-fatality rates were among patients with meningitis, toxoplasmosis and TB: in a multivariate analysis the strongest independent risk factors for death were an abnormal level of consciousness (OR, 9.3; 95\% CI, 3.5-24.6), a haemoglobin concentration below 8 g/dl (OR, 4.2; 95\% CI, 1.4-12.8) and age \textgreater 40 years (OR, 3.9; 95\% CI, 1.5-10.2). CONCLUSIONS: Our data show that, as in industrialized countries, most HIV-infected individuals admitted to and dying in hospital in Abidjan are profoundly immunosuppressed. Potentially preventable infections are the main causes of in-hospital morbidity and mortality among HIV-infected persons in Abidjan, and the evaluation of appropriate primary prophylactic regimes is a priority.

@article{grant_profound_1997, abstract = {{OBJECTIVES:} To describe the spectrum of opportunistic disease in {HIV-infected} patients admitted to hospital in Abidjan, Côte {d'Ivoire,} and to describe the level of immunosuppression at which these diseases occur. {DESIGN:} Cross-sectional study. {SETTING:} In-patient wards of the University Hospital Infectious Diseases Unit. {PATIENTS:} A total of 250 adult patients recruited by systematic sampling at the point of hospital admission. {MAIN} {MEASURES:} {HIV} status; {CD4} count; diagnoses, confirmed by microbiological/radiological investigations whenever possible; and outcome of hospitalization (death or discharge). {RESULTS:} Overall, 79\% patients were {HIV-positive.} The most frequent diagnoses in {HIV-positive} patients were septicaemia (20\%, with non-typhoid salmonellae, Escherichia coli and Streptococcus pneumoniae the most common organisms), {HIV} wasting (16\%), meningitis (14\%), tuberculosis {(TB;} 13\%), isosporiasis (10\%), cerebral toxoplasmosis (7\%) and bacterial enteritis (7\%). Most {HIV-positive} patients had evidence of severe immunosuppression: 39\% had {CD4} counts {\textless} 50 x 10(6)/l, 17\% had 50-99 x 10(6)/l, and 20\% had 100-199 x 10(6)/l. In-hospital mortality among {HIV-positive} patients was 38\% compared with 27\% among {HIV-negative} patients [age-adjusted odds ratio {(OR),} 1.5; 95\% confidence interval {(CI),} 0.7-2.9]. Among {HIV-positive} patients, the highest case-fatality rates were among patients with meningitis, toxoplasmosis and {TB:} in a multivariate analysis the strongest independent risk factors for death were an abnormal level of consciousness {(OR,} 9.3; 95\% {CI,} 3.5-24.6), a haemoglobin concentration below 8 g/dl {(OR,} 4.2; 95\% {CI,} 1.4-12.8) and age {\textgreater} 40 years {(OR,} 3.9; 95\% {CI,} 1.5-10.2). {CONCLUSIONS:} Our data show that, as in industrialized countries, most {HIV-infected} individuals admitted to and dying in hospital in Abidjan are profoundly immunosuppressed. Potentially preventable infections are the main causes of in-hospital morbidity and mortality among {HIV-infected} persons in Abidjan, and the evaluation of appropriate primary prophylactic regimes is a priority.}, added-at = {2011-03-11T10:05:34.000+0100}, author = {Grant, A D and Djomand, G and Smets, P and Kadio, A and Coulibaly, M and Kakou, A and Maurice, C and Whitaker, J P and {Sylla-Koko}, F and Bonard, D and Wiktor, S Z and Hayes, R J and Cock, K M De and Greenberg, A E}, biburl = {https://www.bibsonomy.org/bibtex/2d6bdab65ea3a821d7690b258bf5afc8a/jelias}, interhash = {32e5f0017e907b995512c2111e90193f}, intrahash = {d6bdab65ea3a821d7690b258bf5afc8a}, issn = {0269-9370}, journal = {{AIDS} {(London,} England)}, keywords = {Adolescent, Adult, Age Aged, Analysis, Bacterial Cote Count, Enteritis, Factors, Female, Hemoglobins, Hospitalization, Humans, Immunosuppression, Infections, Lymphocyte Male, Meningitis, Middle Multivariate Opportunistic Risk Studies, Syndrome, Toxoplasmosis, Tuberculosis Wasting {AIDS-Related} {CD4} {Cross-Sectional} {HIV-1,} {HIV-2,} {HIV} {d'Ivoire,}}, month = sep, note = {{PMID:} 9302446}, number = 11, pages = {1357--64}, timestamp = {2011-03-11T10:05:46.000+0100}, title = {Profound immunosuppression across the spectrum of opportunistic disease among hospitalized {HIV-infected} adults in Abidjan, Côte {d'Ivoire}}, url = {http://www.ncbi.nlm.nih.gov/pubmed/9302446}, volume = 11, year = 1997 }