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Abstract
Causes of severe morbidity in HIV-infected patients. Aquitaine cohort 2000-2004: the importance of bacterial infections, cardio-vascular, digestive, and psychiatric morbidity
F. Bonnet1, G. Chêne2, S. Lawson-Ayayi2, M. Dupon3, J.-L. Pellegrin4, R. Thiébaut2, P. Morlat1, Groupe d'Epidemiologie Clinique du SIDA en Aquitaine
Background:
The increase of life expectancy of HIV-infected patients is associated with a decreased incidence of AIDS events but little is known about the evolution of other causes of severe morbidity because, in most of the cohorts, only AIDS events are systematically recorded.
Methods:
Among a large cohort of HIV-infected patients where all severe events are systematically recorded and coded according to the International Classification of Diseases 10th revision (ICD10), we aimed at studying the evolution of the severe morbidities leading to hospitalisation and/or deaths between 2000 and 2004.
Results:
1186/3863 patients were hospitalised at least once, resulting in 1854 hospitalisations for medical concerns. The yearly rate of hospitalisation / hospitalised patients decreased over time between 2000 and 2004 from 172 to 92 and from 132 to 78 per 1000 patients, respectively. 21% of events were bacterial infections, 20% AIDS events (24% in 2000 to 11% in 2004), 10% psychiatric disorders, 9% cardiovascular events (5 to 15%), 7% hepatic/gastro-intestinal disorders (cirrhosis 60%), 6% other viral infections, 5% non-AIDS cancers, and 4% iatrogenic events (5 to 3%). CD4 count at the time of event was below 200/mm3 in 37% of patients and above 500/mm3 in 19%.
As compared to other patients, patients with events were older (41.5 vs 39.9 years; P<0.001), with lower CD4 count (250/mm3 vs 489/mm3; P<0.001). They were also more likely to be contaminated through intra venous drug use (30 vs 19%; P<0.001), positive for hepatitis C (37 vs 27%; P<0.001) and at AIDS stage (43 vs 14%).
Conclusions:
Severe morbidity has shifted from AIDS-related to non AIDS-related causes. Ageing, co-morbidities (hepatitis, addictive behaviours) might explain this evolving distribution. Immunodepression, even moderate may also have a role in the development of non-AIDS morbidity. Limiting endpoints to AIDS events and death could be misleading in the interpretation of prognostic and therapeutic studies.
AIDS 2006 - XVI International AIDS Conference
Abstract no.
MOPDB02
Suggested Citation
"F.Bonnet, et al.
Causes of severe morbidity in HIV-infected patients. Aquitaine cohort 2000-2004: the importance of bacterial infections, cardio-vascular, digestive, and psychiatric morbidity.
Poster discussion:
AIDS 2006 - XVI International AIDS Conference:
Abstract no.
MOPDB02"
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