The mortality and pathology of HIV infection in a West African city

Lucas, Sebastian; Hounnou, A.; Peacock, Christopher; Beaumel, A; Djomand, Gaston; NʼGbichi, Jean-Marie; Yeboue, Kouadio; Hondé, M.; Diomandé, Mohamed; Giordano, Christian; Doorly, Ronan; Brattegaard, K.; Kestens, Luc; Smithwick, Ronald W.; Kadio, A.; Ezani, Niamkey; Yapi, A; Cock, Kevin M. De

doi:10.1097/00002030-199312000-00005

Cited by 508 publications

(326 citation statements)

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“…Epidemiologic differences, both regional and between different countries are showed in Latin American and African studies when compared to North American and European studies 11,24,25,26 . Several changes in the digestive system are observed only at autopsy 3,19,20 , however, there is only one study specifically evaluating the scope of gastrointestinal pathology in AIDS in Brazil 5 and another one elsewhere 22 .…”

Section: Introductionmentioning

confidence: 93%

Morphological changes in the digestive system of 93 human immunodeficiency virus positive patients: an autopsy study

Guimarães

Silva

Micheletti

et al. 2012

Rev. Inst. Med. trop. S. Paulo

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SUMMARYInvolvement of the digestive system in patients with acquired immunodeficiency syndrome (AIDS) is frequent and many changes in these patients are diagnosed only at autopsy. There are few studies of autopsy with detailed analysis of this system and only one was conducted in Brazil. We evaluated each segment of the digestive system in 93 consecutive autopsies of patients infected with human immunodeficiency virus (HIV) and the importance of these lesions to death. Of these, 90 (96.8%) patients had AIDS. We reviewed medical records, autopsy reports and histological sections from tongue to rectum stained with hematoxylin-eosin. When necessary, we analyzed special stains and immunohistochemistry to investigate infections. There was damage to the digestive system in 73 (78.5%) cases. The most common infections were candidiasis (42%), cytomegalovirus (29%), histoplasmosis (11.8%), toxoplasmosis (9.7%) and mycobacterial infection (9.7%). Malignancies were rare, present in four (4.3%) cases (two Kaposi's sarcoma, one adenocarcinoma and one metastatic embryonal carcinoma). All segments showed lesions: tongue (48.6%), esophagus (44.8%), stomach (44.7%), colon (43.2%) and small intestine (28.9%). The lesions found were immediate cause of death in five (5.4%) cases. In another 36 (38.7%) cases the basic disease was systemic and also compromised the digestive system.

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Section: Introductionmentioning

confidence: 93%

Morphological changes in the digestive system of 93 human immunodeficiency virus positive patients: an autopsy study

Guimarães

Silva

Micheletti

et al. 2012

Rev. Inst. Med. trop. S. Paulo

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“…8, 9 They have consistently been shown to be major causes of death among HIV-infected patients in settings where access to diagnosis and treatment is low. [10][11][12][13][14][15][16] These diseases triggered the question "Should we start ART earlier?" in low-income countries.…”

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confidence: 99%

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

2015

N Engl J Med

999

433

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BACKGROUND: In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast. METHODS: We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 months. We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies. RESULTS: A total of 2056 patients (41% with a baseline CD4+ count of ≥500 cells per cubic millimeter) were followed for 4757 patient-years. A total of 204 primary end-point events were observed (3.8 events per 100 person-years; 95% confidence interval [CI], 3.3 to 4.4), including 68 in patients with a baseline CD4+ count of at least 500 cells per cubic millimeter (3.2 events per 100 person-years; 95% CI, 2.4 to 4.0). Tuberculosis and invasive bacterial diseases accounted for 42% and 27% of primary end-point events, respectively. The risk of death or severe HIV-related illness was lower with early ART than with deferred ART (adjusted hazard ratio, 0.56; 95% CI, 0.41 to 0.76; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.56; 95% CI, 0.33 to 0.94) and lower with IPT than with no IPT (adjusted hazard ratio, 0.65; 95% CI, 0.48 to 0.88; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.61; 95% CI, 0.36 to 1.01). The 30-month probability of grade 3 or 4 adverse events did not differ significantly among the strategies. CONCLUSIONS: In this African country, immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT, both overall and among patients with CD4+ counts of at least 500 cells per cubic millimeter. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis; TEMPRANO ANRS 12136 ClinicalTrials.gov number, NCT00495651.)

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“…In resource poor countries, for example in Africa with a toxoplasmosis seroprevalence of up to 78% [19] and more HIV-infected patients with very low CD4 cell counts, prevalence of pulmonary toxoplasmosis might be higher than in industrialized countries. However, in these countries diagnostic possibilities are often very limited and in the absence of respiratory samples clinicians need to consider an empiric toxoplasmal therapy, particularly in the presence of risk factors (see above) and non-responsiveness to therapy.…”

Section: Discussionmentioning

confidence: 99%