Rates of AIDS or death, tuberculosis, and invasive bacterial diseases are substantial in patients with CD4 cell counts ≥200 cells/μL. Tuberculosis and bacterial diseases should be the most important outcomes in future trials of early ART in sub-Saharan Africa.

Introduction. Surgical treatment of perforated peptic ulcer (PPU) is a challenge for surgeons in Africa. Aim. To determine risk factors of postoperative complications or mortality among black Ivoirian patients with PPU. Methods. All 161 patients (median age = 34 years, 90.7 male) operated on for PPU in the visceral and general surgery unit were enrolled in a retrospective cohort study. Variables were studied with Kaplan Meier and Cox proportional hazard models. Results. Among 161 patients operated on for PPU, 36 (27.5%) experienced complications and 31 (19.3%) died. Follow-up results were the incidence of complications and mortality of 6.4 (95% CI: 4.9–8.0) per 100 person-days and 3.0 (95% CI: 1.9–4.0) per 100 person-days for incidence of mortality. In multivariate analysis, risk factors of postoperative complications or mortality were comorbidities (HR = 2.1, P = 0.03), tachycardia (pulse rate > 100/minutes) (HR = 2.4, P = 0.02), purulent intra-abdominal fluid collection (HR = 2.1, P = 0.04), hyponatremia (median value ≤ 134 mEq/L) (HR = 2.3, P = 0.01), delayed time of hospital admission > 72 hours (HR = 2.6, P < 0.0001), and delayed time of surgical intervention between 24 and 48 hours (HR = 3.8, P < 0.0001). Conclusion. The delayed hospital admission or surgical intervention and hyponatremia may be considered as additional risk of postoperative complications or mortality in Black African patients with PPU.

Objective To estimate the probability of reaching the criteria for starting highly active antiretroviral therapy (HAART) in a prospective cohort of adult HIV-1 seroconverters in Abidjan, Côte d'Ivoire. Methods We recruited participants from HIV-positive donors at the blood bank of Abidjan for whom the delay since the estimated date of seroconversion (midpoint between last negative and first positive HIV-1 test) was < 36 months. Participants were offered early trimethoprim-sulfamethoxazole (cotrimoxazole) prophylaxis, twice-yearly measurement of CD4 count and we made standardized records of morbidity. We used the Kaplan-Meier method to estimate the probability of reaching the criteria for starting HAART according to WHO 2006 guidelines. Findings 217 adults (77 women (35%)) were followed up during 668 person-years (PY). The most frequent diseases recorded were mild bacterial diseases (6.0 per 100 PY), malaria (3.6/100 PY), herpes zoster (3.4/100 PY), severe bacterial diseases (3.1/100 PY) and tuberculosis (2.1/100 PY). The probability of reaching the WHO 2006 criteria for HAART initiation was estimated at 0.09, 0.16, 0.24, 0.36 and 0.44 at 1, 2, 3, 4 and 5 years, respectively. Conclusion Our data underline the incidence of the early HIV morbidity in an Ivorian adult population and provide support for HIV testing to be made more readily available and for early follow-up of HIV-infected adults in West Africa.Bulletin of the World Health Organization 2007;85: 116-123. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. IntroductionExperts from the World Health Organization (WHO) and the United Nations Joint Programme on AIDS (UNAIDS) have estimated that at the end of 2005, 65% of the 39 million people with HIV worldwide were living in sub-Saharan Africa. 1 In Africa, only a small proportion of people who need highly active antiretroviral therapy (HAART) are currently being treated. However, the number who receive HAART has been increasing rapidly since 2004, and will continue to increase within the next few years thanks to national and international funds and initiatives.In 2003 and 2006, WHO experts defined criteria for initiating HAART in low-resource areas based on clinical criteria and, depending on the availability of laboratory facilities, either CD4 count or total lymphocyte count. Since cohort studies of patients from the time of HIV seroconversion are rare, little is known Methods PatientsRecruitment for the The Primo-CI ANRS 1220 prospective cohort started in 1997 in the HIV care clinic (FonSIDA clinic) of the Centre National de Transfusion Sanguine (CNTS), at the national blood bank of Abidjan.2 The study protocol was approved by the ethics committees of the national Ivorian program on AIDS and the institutional review board of the French Agency for Research on AIDS (ANRS).In the Côte d'Ivoire, blood donors are adult volunteers who are not paid. Blood donations are limited to five per year in men and four per year in women. ...

Bill & Melinda Gates Foundation, Wellcome Trust.