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Abstract
Introduction. HIV infection remains a global health priority. In Guinea, a 2013 study reported an 18.1% mortality rate among people living with HIV (PLHIV). Updated data are lacking. This study aimed to determine factors associated with morbidity and mortality in PLHIV hospitalized at the Donka Training and Research Care Unit (USFR-Donka) in Conakry. Methods. We conducted a retrospective descriptive and analytical study including all patients aged 15 years and older hospitalized from November 16, 2016, to December 31, 2020. Patients who died within 48 hours of admission were excluded. Demographic, clinical, biological, therapeutic, and outcome data were collected and analyzed. Results. Of 2,236 admitted patients, 1,861 (83.2%) were included. Mean age was 38.7 ± 12 years (range 15–79). Women accounted for 61.5% (sex ratio 0.62). At hospitalization, 61.7% were at WHO stage IV, 70.3% had associated tuberculosis, and 61.7% had severe malnutrition (BMI < 16.5 kg/m²). Viral load was detectable (>40 copies/mL) in 89.6%, and CD4 count was <200 cells/mm³ in 82.1%. Severe anemia (<8 g/dL) affected 47.6%, renal failure (creatinine >150 µmol/L) 44.4%, and liver cytolysis (SGPT >40 IU/L) 19.8%. The preferred regimen (TDF/3TC/EFV) was prescribed in 58.9%. Overall mortality was 32.9% (613 deaths). Factors associated with death in bivariate analysis were: liver failure (p < 0.00001), renal failure (p = 0.0003), WHO stage IV (p < 0.0001), and CD4 count <50 cells/mm³ (p < 0.0001). Conclusion. In‑hospital mortality among PLHIV remains very high in Donka, affecting one‑third of patients. It is linked to late diagnosis (advanced stage, severe immunosuppression) and associated comorbidities (tuberculosis, malnutrition, organ failure). Earlier screening, rapid ART initiation, and integrated management of comorbidities are urgently needed.
RÉSUMÉ
Introduction. L'infection par le VIH reste une priorité sanitaire mondiale. En Guinée, une étude de 2013 rapportait une mortalité de 18,1 % chez les personnes vivant avec le VIH (PVVIH). Depuis, peu de données actualisées sont disponibles. Cette étude visait à déterminer les facteurs associés à la morbidité et à la mortalité des PVVIH hospitalisées à l'Unité de Soins, de Formation et de Recherche (USFR) Donka, à Conakry. Méthodes. Nous avons mené une étude rétrospective descriptive et analytique incluant tous les patients âgés de 15 ans et plus, hospitalisés du 16 novembre 2016 au 31 décembre 2020. Étaient exclus les patients décédés dans les 48 heures suivant l'admission. Les données démographiques, cliniques, biologiques, thérapeutiques et évolutives ont été recueillies et analysées. Résultats. Sur 2 236 patients admis, 1 861 (83,2 %) ont été inclus. L'âge moyen était de 38,7 ± 12 ans (extrêmes 15–79). Les femmes représentaient 61,5 % (sex‑ratio 0,62). Au moment de l'hospitalisation, 61,7 % des patients étaient au stade OMS IV, 70,3 % présentaient une tuberculose associée, et 61,7 % une dénutrition sévère (IMC < 16,5 kg/m²). La charge virale était détectable (> 40 copies/mL) chez 89,6 % des patients, et le taux de CD4 inférieur à 200 cellules/mm³ chez 82,1 %. Une anémie sévère (< 8 g/dL) concernait 47,6 % des patients, une insuffisance rénale (créatininémie > 150 µmol/L) 44,4 %, et une cytolyse hépatique (SGPT > 40 UI/L) 19,8 %. Le régime thérapeutique préférentiel (TDF/3TC/EFV) était prescrit dans 58,9 % des cas. La mortalité globale s'élevait à 32,9 % (613 décès). En analyse bivariée, les facteurs associés au décès étaient : l'insuffisance hépatique (p < 0,00001), l'insuffisance rénale (p = 0,0003), le stade OMS IV (p < 0,0001), et le taux de CD4 < 50 cellules/mm³ (p < 0,0001). Conclusion. La mortalité hospitalière des PVVIH reste très élevée à Donka, touchant un tiers des patients. Elle est liée à un diagnostic tardif (stade avancé, immunosuppression sévère) et aux comorbidités associées (tuberculose, dénutrition, défaillances viscérales). Un dépistage plus précoce, une mise sous traitement antirétroviral rapide et une prise en charge intégrée des comorbidités sont urgents.
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References
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- 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.