HIV-1-related morbidity in adults, Abidjan, Cote d'Ivoire:: A nidus for bacterial diseases

We studied mortality and morbidity in 270 HIV-1-infected adults (60%, women, median age 31 years, mean baseline CD4 count 331/mm(3)) observed in a follow-up that lasted a median 10 months in Cote d'Ivoire. Survival and probability of remaining free from any episode of morbidity at 12 month,, were 0.80 and 6.50, respectively. Baseline CD4 count < 200/mm(2) was the only variable associated with global morbidity and mortality, with hazard ratios of 2.50 and 7.57, respectively. The most frequent causes of morbidity were severe bacterial infections (incidence rate: 26.1 per 100 person-years [py]), followed by oral candidiasis (22.3% py), unexplained weight loss over 10% of baseline body weight (13.3% py), tuberculosis (10.1% py), unexplained chronic diarrhea (9.7% py), and isosporiasis (5.1% py). Nontyphoid Salmonella accounted for 37% of isolated strains during severe bacterial infections, followed by Streptococcus pneumoniae (34%), Escherichia coli (15%), and Shigella species (71%). A significant part of bacterial morbidity occurred in patients with baseline CD4 count greater than or equal to 200/mm(3), in whom the incidence rate of bacterial diseases was 21.3% py and the probability of remaining free from any bacterial infection at 12 months was 0.80 (vs. 36.4% py and 0.71 in patients with baseline CD4 count < 200/mm(3); p = .07).