African Journal of Internal Medicine

Full Length Research paper

Profile of people living with HIV in intensive medical care in Togo: epidemiological and evolutionary aspect

Ouedraogo SM¹, Djibril MA², IBA BA Josaphat³, Balaka A², Tchamdja T², Djagadou K², Ouedraogo M⁴, Agbétra A², Drabo YJ⁵

¹Department of Internal Medicine, University Hospital Souro Sanou (UH SS), Burkina Faso.

²Intensive medical care, University Hospital Sylvanus Olympio, Lomé.

³Department of Internal Medicine, University hospital -L, Gabon.

⁴Pneumo Service phthisiology, University hospital -YO Yalgado Ouedraogo, Burkina Faso.

⁵Department of Internal Medicine, University hospital -YO Yalgado Ouedraogo, Burkina Faso.

Corresponding Author. E-mail: [email protected]. Tel. (00226) 70207076.

Abstract

Aim: To describe both the epidemiology and prognosis of people living with HIV (PLHIV) hospitalized in intensive care.

Methodology: it is a prospective cross-sectional study conducted at the CHU Sylvanus Olympio, Lomé over a period of 12 months on known HIV infected patients or patients newly diagnosed on admission, from both sexes, aged over 15 years, hospitalized during the period between January 1^st and December 31^st, 2011. We studied the socio-demographic parameters, the reason for hospitalization, the infections and affections found and  their evolution.

Results: During our study period 124 patients (46 men and 78 women) were selected out of 1130, i.e. a rate of 10.9%, with a sex ratio of 0.6. The average age of our patients was 41 ± 15.5 years, ranging from 20 years to 69 years. On admission, 41% (51 patients) were aware of their HIV-positive status, with 30% on antiretroviral treatment. The reasons for admission were dominated by altered consciousness, repetitive seizures, severe dehydration, severe anemia with impaired general condition and paroxysmal dyspnea with respective rates of 48.4%, 22, 6%, 12% 32% and 4.3%. The clinical manifestations were dominated by hemi corporal sensory motor deficit (56.7%), fever (53%) and coma (48.4%). Biologically, 83.6% had a CD4 rate below 200 elements per mm³. Anemia was severe in 32 % out of the 87% of cases of anemia. This anemia is associated with a lymphopenia or neutropenia or thrombocytopenia in respectively 63.3 %, 57.1% and 20 % of cases. Creatinine and blood urea were elevated in 20% of cases. Infections and diseases found were dominated by cerebral abscesses (40%), severe anemia (32%), gastroenteritis (12%) and meningitis (11.2%). Brain abscess were represented by toxoplasmosis in 90% of cases. Meningitis was bacterial in 5 cases (pneumococcus), fungal (Cryptococcus) in 3 cases. Overall mortality was 43% with a higher lethality for meningitis and severe anemia.

Conclusion: the proportion of patients with HIV infection is high in medical intensive care unit in Togo. The admission patterns are dominated by neurological diseases including neurological conditions i.e coma. Infections and/or affections are found but dominated by various cerebral abscesses (toxoplasmosis). Mortality in patients with HIV infection in intensive care is high and seems to be improved by proper management of toxoplasmosis abscesses.

Keywords: Intensive care, HIV, cerebral toxoplasmosis, Togo.