3.1. Epidemiological data
Of the 804 patients included, 494 (61,44%) were followed in the health district of Ziguinchor and 310 (38,56%) in the health district of Bignona. Majority of patients were female (597/804) (74,25%), i.e. a sex ratio (F/M) of 2.88. The average age was 45.61 years ± 13.01 years with extremes of 15 to 96 years. The 46-60 age group was the most represented, 36.94% or 297 cases. Patients were married in 56.2% of cases, 42% among them were polygamous. Widowers accounted for 16.42% of cases. Table I shows the epidemiological profile of PvHIV in our study.
Table I: Epidemiological aspects of people living with HIV
Variables
|
n =804
|
Percent (%)
|
Sex
|
|
|
Male
|
207
|
25,75
|
Female
|
597
|
74.25
|
Age
|
|
|
14-30
|
112
|
13,93
|
31-45
|
282
|
35,07
|
46-60
|
297
|
36,94
|
> 60
|
113
|
14.05
|
Marital status
|
|
|
Married
|
494
|
61,44
|
Widows
|
132
|
16,42
|
Single
|
115
|
14,30
|
Divorced
|
63
|
7,84
|
Circumstances of discovery of HIV
|
|
|
Infections opportunistes
|
536
|
66.92
|
Pregnancy
|
93
|
11.61
|
Drugs consomption
|
81
|
10.11
|
Tuberculosis
|
61
|
07.55
|
Family screening
|
24
|
03,00
|
Blood donation
|
02
|
0.25
|
|
|
|
Clinical stage according to WHO
|
|
|
1
|
307
|
38.18
|
2
|
211
|
26.24
|
3
|
241
|
29.98
|
4
|
45
|
5.60
|
3.2. Clinical data
We had 286 patients (35.58%) who were diagnosed at stages 3 and 4 according to WHO. In 358 patients (44.52%), opportunistic infections were the circumstance of discovery. They were dominated by chronic gastroenteritis (29.51%), recurrent non-specific or community-acquired bacterial pneumonia (29.23%), tuberculosis (20.11% with 12.5% of extra-pulmonary forms) , oral or oropharyngeal candidiasis (09.17%), shingles (07.16%), Kaposi (1.15%). A carriage of AgHbs was noted in 10.11%.
According to the virological profile, 82.34% were infected with HIV1. Type 2 was found in 122 (15.17%) patients and the dual profile found in 20 cases (2.49%). The average CD4 count was 327±295/mm3 with extremes of 1 and 2156/mm3. Two hundred and thirteen(213) patients (40.73%) had a CD4 count below 200/mm3 and 117 patients (22.37%) had a CD4 count above 500/mm3 (see table II).
Table II: Immunological and virological data of PvHIV
Variables
|
Headcount (n =804)
|
Pourcentage (%)
|
Viral load (copies/ml)
|
|
|
Undetectable < 20
|
8
|
2,29
|
20 - 1000
|
320
|
91,69
|
1001 - 10000
|
8
|
2,29
|
10001-100000
|
7
|
2,01
|
>100000
|
6
|
1,72
|
LTCD4+ count (cell/mm3)
|
|
|
< 500
|
406
|
50,50
|
≥ 500
|
398
|
49,50
|
3.3. Therapeutic and evolutionary data
Antiretroviral treatment was initiated in 791 patients (98.38%). The antiretroviral regimen combined 2 NRTIs (nucleoside reverse transcriptase inhibitor) with 1 NNTI (non-nucleoside reverse transcriptase inhibitor) in 82.71% of cases. The average duration of follow-up was 3.22±1.33 years (range 1 to 6 years). After 12 months of therapeutic follow-up, the viral load (VL) was carried out in 349 patients and 6.02% had virological failure (CD4 > 1000 copies) with a mean of 3061 copies/mL. Four hundred and ninety (60.95%) patients were regularly followed. Lost to sight and deaths accounted for 25.25% and 6.34% of cases respectively (see Table III).
In multivariate analysis, the occurrence of death was associated with age greater than 65 years (p = 0.027), treatment duration < 12 months (p<0.005), a delayed ARV treatment (CD4 at baseline less than 500 cells/mm3 (p=0.001) and high viral load greater than 1000 copies/mL (p=0.000) at baseline).
Table III: Therapeutic and evolutionary aspects of people living with HIV.
Variables
|
Headcount (n =804)
|
Pourcentage (%)
|
Therapeutic regimen
|
2INTI* +1NNTI**
|
665
|
82,71
|
2INTI +1IP***
|
138
|
17,16
|
2INTI
|
1
|
0,12
|
Evolution aspects
|
Active follow-up
|
489
|
60,90
|
Lost of sight
|
203
|
25,28
|
Transferred
|
60
|
7,47
|
Deceased
|
51
|
6,35
|
*Nucleoside Reverse Transcriptase Inhibitor
** Non-nucleoside reverse transcriptase inhibitor
***Protease inhibitor
Table IV: Bivariate analysis of factors associated with lethality in PLHIV
Variables
|
Deceased n (%)
|
P-value
|
YES
Headcount (%)
|
No
Headcount (%)
|
Sex
|
|
|
|
Male
|
16 (7,73)
|
191 (92,27)
|
0.342
|
Female
|
35 (5,86)
|
562 (94,14)
|
Age at enrollment (years)
|
|
|
|
< 65
|
43 (5.80%)
|
699 (94,20)
|
0,027
|
≥ 65
|
8 (12,90)
|
54 (87,10)
|
Stages according to WHO
|
|
|
|
1-2
|
248 (85,52)
|
505 (98,25)
|
0,000
|
3-4
|
42 (14,48)
|
9 (1,75)
|
LTCD4 + count (cell/mm3)
|
|
|
|
<500
|
37 (9,11)
|
369 (90,89)
|
0.001
|
≥500
|
14 (3,52)
|
384 (96,48)
|
Treatment’s length (months)
|
|
|
|
< 12
|
44 (14,47)
|
260 (85,53)
|
0.000
|
≥ 12
|
7 (1.40)
|
493 (98,60)
|
Viral load
|
|
|
|
<1000
|
4 (1,17)
|
339 (98,83)
|
0.000
|
≥1000
|
47 (10,20)
|
414 (89,80)
|
Table V: Multivariate analysis of factors associated with lethality in PLHIV
Associated factors
|
Odds ratio
|
P-value
|
IC 95%
|
Age>65 ans
|
3,81
|
0,052
|
0,98 -14,7
|
WHO stage 3-4
|
6,73
|
0,000
|
2,60-17,38
|
TARV Length< 12mois
|
4,59
|
0,008
|
1,49- 14,15
|
CD4 < 500
|
2,24
|
0,305
|
0,47-10,50
|
CV> 1000 cp/mm3
|
3,10
|
0,135
|
0,70-13,69
|