Profil actuel des patients infectés par le VIH hospitalisés à Dakar (Sénégal)

Abstract

Ten years after the introduction of the Senegalese Antiretroviral Drug Access Initiative in 1998, we conducted a retrospective study of the epidemiological and clinical profiles and outcome of HIV-infected patients hospitalized in the Infectious Diseases Clinic of Fann Teaching Hospital in Dakar between 2007 and 2008. During these 2 years, 527 HIV-positive patients were included. The average age of the patients was 41 ± 10 years, and the sex-ratio (F/M) was 1.1; 56% of patients were married. The average interval before admission was 40 ± 57 days. Fever (83%), loss of weight (83%) and cough (54%) were the principal symptoms. Tuberculosis (40.9%) and gastrointestinal candidiasis (38.9%) were the commonest opportunistic infections. Most patients were diagnosed at the AIDS stage (88%) and the CD4+ T lymphocyte count was ≤ 200/mm3 in 86% of cases. Hospital fatality was 44% (231/527). Tuberculosis (36%), bacterial pneumonia (18%) and encephalitis (12%) were the most frequent causes of death. Despite the availability of and free access to antiretroviral drugs in Senegal, the mortality associated with HIV infection remains very high due to late diagnosis. The population must be educated to boost early screening and care.

Disease patterns and causes of death of hospitalized HIV‐positive adults in West Africa: a multicountry survey in the antiretroviral treatment era

“…The high fatality we observed among these hospitalized patients and the factors associated with in-hospital mortality have already been described in other African settings [21,33] and may be the consequence of several parameters: the late diagnosis of HIV infection (during hospitalization or less than six months before in the majority of patients in our study) [34] associated with a low CD4 count [35]; the severity of diseases at hospital entry that may be due in part to late presentation; and finally the limited means available for intensive care. TB, cerebral toxoplasmosis and cryptococcosis were the more frequent diseases diagnosed in the patients who died in our study, in agreement with the limited number of autopsy studies performed throughout sub-Saharan Africa [36].…”

“…TB and pneumonia were frequent causes of hospitalization as already reported in HIV-positive individuals throughout sub-Saharan Africa [21,33,37,38]. These diseases remain common within a wide range of CD4 counts [39] and are still the most frequent causes of death in this population [40].…”

Profil clinique et immunologique des patients infectés par le VIH à l’initiation du traitement antirétroviral à Douala

“…Keiser et al avaient également montré que la grande majorité des PVVIH dans les pays à ressources limitées n'accèdent aux soins que lorsqu'elles présentent des symptômes de la maladie (2). Une étude réalisée en (14,18). En effet, l'amaigrissement est une manifestation fréquente observée chez les patients infectés par le VIH.…”

“…Concernant les affections opportunistes, des proportions identiques sont retrouvées mais avec des taux supérieurs au Sénégal (tuberculose 40,9 %; candidose digestive : 38,9 %), en Côte d'ivoire (tuberculose 34,2 % ; toxoplasmose céré-brale 17,9 % ; cryptococcose neuroméningée 8 %) (14,18). Fonquernie et al avaient montré, par une étude comparative entre Français et Africains subsahariens, que la pneumocystose était l'infection opportuniste majoritaire chez les Français et la tuberculose chez les Africains subsahariens (13).…”

Leveraging peer-based support to facilitate HIV care in Kenya

“…Data from SSA indicate that over 50% of HIV diagnoses are made during hospital admission and that linkage and retention rates are as low as 40% and 60%, respectively [1–4]. Hospitalized patients with HIV in SSA often present late with advanced stage disease and life-threatening opportunistic infections, with the subsequent in-hospital mortality ranging from 24% to 44% [5,6] and a 1-year survival probability of only 61% [7]. To reverse this trend, emphasis needs to be placed on improving inpatient HIV care while also supporting the transition to effective outpatient care.…”