[LB53] MORBIDITY CAUSES IN HIV-INFECTED ADULTS BEFORE AND AFTER THE ANTIRETROVIRAL TREATMENT (ART) ERA IN ABIDJAN, COTE D’IVOIRE : DATA FROM THE COTRAME ANRS 1203 COHORT STUDY

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] MORBIDITY CAUSES IN HIV-INFECTED ADULTS BEFORE AND AFTER THE ANTIRETROVIRAL TREATMENT (ART) ERA IN ABIDJAN, COTE D’IVOIRE : DATA FROM THE COTRAME ANRS 1203 COHORT STUDY

[AUTHOR(S):] C. Seyler¹, S. Touré¹, E. Messou¹, N. Dakoury-Dogbo¹, A. Anzian¹, T. Ouassa¹, T. N'Dri-Yoman², R. Salamon³, X. Anglaret³
¹Programme PAC-CI, Abidjan, Côte d'Ivoire, ²Service de Gastro-entérologie, CHU de Yopougon, Abidjan, ³INSERM U 593, Bordeaux, France

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. LB53

[ABSTRACT:] Background: There is differences in the spectrum of HIV-related morbidity between sub-Saharan Africa and industrialized countries. Data on morbidity causes in patients receiving ART in sub-Saharan Africa are scarce.

Objectives: To compare the incidence rates of the major causes of severe morbidity in HIV- infected adults with and without ART in Abidjan.

Methods: Since 1996, 723 HIV-infected adults have been prospectively followed in the Cotrame cohort in Abidjan. Since 1998, 126 of them started ART . We compared available data on severe morbidity between : (i) group 1: patients who where included in the cohort between 1996 and 1998 with a baseline CD4 count < 200/mm³ and were followed under cotrimoxazole but no ART ; (ii) group 2: patients who started ART after 1998. Severe morbidity was defined as all episodes of morbidity leading to at least one day in hospital.

Results: The 166 patients of group 1 (60% women, median CD4 count 100/mm³ at baseline) and 126 patients of group 2 (81% women, median CD4 count 137/mm³ at ART initiation) were followed during a mean time of 16 months and 21 months, respectively. Gender, age, BMI and WHO stages at baseline were not significantly different. The most frequent causes of severe morbidity were acute unexplained fever (group 1: 9.1 /100 patient-years [/100p-y], group 2: 12.2 /100p-y, p=0.37), severe bacterial diseases (25.0 vs 9.2/100p-y, p<0.001), non-specific enteritis (23.0 vs 9.1, p=0.001), tuberculosis (6.9 vs 2.4, p<0.001), and malaria (2.4 vs 2.4, p=0.97).

Conclusion: Though with reduced incidence of morbidity when comparing with historical data before the ART era, patients now starting ART at low CD4 count need to continue to benefit from large access to prevention and care of morbidity causes (mainly bacterial diseases, tuberculosis and malaria).

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