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Open Access Highly Accessed Research article

Incidence of serious morbidity in HIV-infected adults on antiretroviral therapy in a West African care centre, 2003-2008

Yao Abo1*, Albert Minga1, Hervé Menan12, Christine Danel134, Timothée Ouassa12, Lambert Dohoun1, Germain Bomisso1, Anthony Tanoh5, Eugène Messou16, Serge Eholié17, Charlotte Lewden34 and Xavier Anglaret134

Author Affiliations

1 Programme PAC-CI, Centre Hospitalier Universitaire (CHU) de Treichville, 18 BP 1954, Abidjan, Côte d’Ivoire

2 Centre de Diagnostic et de Recherche sur le SIDA et les Maladies Opportunistes (CeDReS), Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d’Ivoire

3 INSERM, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France

4 Univ. Bordeaux, ISPED, Bordeaux, France

5 Fondation Ariel Glaser pour la lutte contre le SIDA Pédiatrique, Abidjan, Côte d’Ivoire

6 Centre de Prise en charge de Recherche et de Formation (CePReF), Hôpital Yopougon Attié, Abidjan, Côte d’Ivoire

7 Service de Maladies Infectieuses et Tropicales, Centre hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d’Ivoire

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BMC Infectious Diseases 2013, 13:607  doi:10.1186/1471-2334-13-607

Published: 27 December 2013

Abstract

Background

In resource-limited settings, scaling-up antiretroviral treatment (ART) has required the involvement of decentralized health facilities with limited equipment. We estimated the incidence of serious morbidity among HIV-infected adults receiving ART in one of these HIV routine care center in sub-Saharan Africa.

Methods

We conducted a prospective study at the Centre Medical de Suivi des Donneurs de Sang (CMSDS), which is affiliated with the National Centre for Blood Transfusion in Abidjan, Côte d’Ivoire. Adult patients infected with HIV-1 or HIV-1/HIV-2 who initiated ART between January 2003 and December 2008 were eligible for the study. Standardized clinical data were collected at each visit. Serious morbidity was defined as a new episode of malaria, WHO stage 3–4 event, ANRS grade 3–4 adverse event, or any event leading to death or to hospitalization.

Results

1008 adults, 67% women, with a median age of 35 years, and a median pre-ART CD4 count of 186/mm3 started ART and were followed for a median of 17.3 months. The overall incidences of loss to follow-up, death, and attrition were 6.2/100 person-years (PY) [95% CI 5.1-7.2], 2.3/100 PY [95% CI 1.6-2.9], and 8.1/100 PY [95% CI 7.0-9.4], respectively. The incidence of first serious event was 11.5/100 PY overall, 15.9/100 PY within the first year and 8.3/100 PY thereafter. The most frequently documented specific diagnoses were malaria, tuberculosis, bacterial septicemia and bacterial pneumonia.

Conclusion

Among HIV-infected adults followed in routine conditions in a West African primary care clinic, we recorded a high incidence of serious morbidity during the first year on ART. Providing care centers with diagnostic tools and standardizing data collection are necessary steps to improve the quality of care in primary care facilities in sub-Saharan Africa.

Keywords:
Antiretroviral therapy; Serious morbidity; Routine care; Côte d’Ivoire