ABSTRACT
BACKGROUND: Recently, serious morbidity events associated with initial glomerular filtration rate (GFR) have been described during HIV infection, but this is insufficiently investigated in sub-Saharan Africa very affected by HIV. OBJECTIVE: To assess the impact of baseline GFR prevailing during the first semester of the HIV infection management on six-year survival in peoples taking antiretroviral therapy. PATIENTS AND METHODS: Closed retrospective cohort study. The death was the expected outcome, the baseline GFR (mL/min/1.73m2) in the first semester of the follow-up was the main exposure. Kaplan-Meier method, Cox regression were used for analysis. RESULTS: According to baseline GFR: <60, 60-89 and≥90, the six-year survival was 81.6%; 95.8% and 96.4% (P=0.067 Breslow). Adjusted hazard ratio for baseline GFR<60 and 60-89 (vs. ≥90) were respectively 5.4 (95%CI: 1.4-19.9; P=0.012) and 1.2 (95%CI: 0.3-4.0; P=0.754). The etiological fraction of deaths attributable to baseline GFR: GFR<60: 81% (95%CI: 0.31-0.95), GFR=60-89: 18.0% (95%CI: -0.7-0.8). Prognostic concordance index=0.84 (95%CI: 0.59-0.95) for GFR<60 and 0.55 (95%CI: 0.27-0.81) for GFR 60-89. DISCUSSION: The etiological fraction of death and prognostic concordance index associated to baseline GFR level increase significantly with decline of baseline GFR. CONCLUSION: Baseline GFR seems to predict the six-year survival in African sub-Saharan patients treated for HIV.
Subject(s)
Glomerular Filtration Rate , HIV Infections/mortality , HIV Infections/physiopathology , Adolescent , Adult , Africa South of the Sahara , Anti-Retroviral Agents/therapeutic use , Cohort Studies , Female , HIV Infections/drug therapy , Humans , Male , Middle Aged , Predictive Value of Tests , Prognosis , Retrospective Studies , Survival Rate , Time Factors , Young AdultABSTRACT
The objective of our study was to determining the epidemiological, diagnosis and evolutionary aspects of pathologies admitted for care in the service of internal medicine between January 1, 2007 to December 31, 2009. MATERIALS AND METHODS: A cross-sectional retrospective and descriptive study was conducted over three years, from the review of medical records of patients admitted to the Department of internal medicine of the Souro Sanou university hospital. RESULTS: Our study concerned 5362 patients. The average age had been 43.10 years old ±12.2. The sex ratio was 1.16: 1. The majority of our patients were from a low socio-economic background. HIV/AIDS had been the most frequent condition with the rate of admission of 24%, followed by cerebral vascular accidents with 8.6%. The recovery rate was of 53.9% and an overall mortality of 33.3%. This mortality had been dominated by infectious and parasitic diseases including HIV/AIDS with a rate of 27.8% of the overall mortality. Early mortality remains high with a rate of 37.4%. CONCLUSION: In spite of the epidemiological transition marked by the emergence of the cardio-metabolic diseases in the countries of the South, infection by HIV always constitutes the main pathology met in the Department of internal medicine of the Souro Sanou university hospital, it is responsible for a high mortality cause of mortality. The emphasis must be placed on early treatment and especially the communication for the change of behavior aiming at an early screening of the HIV. This would allow to reduce effectively the AIDS-related lethality to internal medicine.
L'objectif de notre étude était de déterminer les aspects épidémiologique, diagnostique et évolutif des pathologies prises en charge en hospitalisation dans le service de médecine interne du 1er janvier 2007 au 31 décembre 2009. MÉTHODES: nous avons mené une étude transversale rétrospective à visée descriptive sur trois ans, à partir de revue de dossiers médicaux de patients admis dans le service de médecine interne du Centre Hospitalier Universitaire Souro Sanou (CHU SS). RÉSULTATS: étaient concernés 5362 patients. L'âge moyen était de 43,10 ans ± 12,2, avec un sex- ratio de 1,16 :1. La majorité de nos patients avaient un faible niveau de vie socio-économique. L'infection par le VIH/SIDA était l'affection la plus fréquente avec un taux d'admission de 24%, suivi des AVC avec 8,6%. Le taux de guérison était de 53,9% et celui de la mortalité globale de 33,3%. Cette mortalité était dominée par maladies infectieuses notamment l'infection par le VIH/SIDA avec un taux de 27,8%. La mortalité précoce était de 37,4% (< 3 jours). CONCLUSION: malgré la transition épidémiologique marquée par l'émergence des maladies cardiométaboliques dans les pays du sud, l'infection par le VIH constitue toujours la principale pathologie rencontrée dans le service de médecine interne du CHUSS, elle est responsable d'une mortalité élevée. L'accent doit être mis sur le traitement précoce et surtout la communication pour le changement de comportement visant un dépistage précoce du VIH. Ceci permettrait de réduire efficacement la létalité li&e au sidia en médecine interne.
