Causes of fever in HIV-1 infected adults - Out-patient surveillance withinthe framework of the ANRS 059 study in Abidjan, Ivory Coast

Objective Describe the causes of fever in HIV-1 infected adults in Abidjan, Ivory Coast. Methods Exhaustive analysis of all the morbid episodes with raise in temper ature to above 37.5 degreesC in patients followed-up prospectively, within the framework of the ANRS 059 study from April 1996 to March 1998. Results One hundred and four patients presented 269 episodes of fever. At t he start of these episodes, the mean CD4 count was of 311 /mm(3) fever had lasted a mean of 3.4 days and mean body temperature was 38.7 degreesC. The 269 episodes lead to 288 diagnoses: 152 specific etiologic diagnoses and 13 6 non-specific syndrome diagnoses. Community bacterial infections represent ed 55% of the specific diagnoses, followed by malaria (16 %) and tuberculos is (12 %). The mean CD4 count during the bacterial episodes was 208/mm(3), in malaria 384/mm(3) and in tuberculosis 245/mm(3). Non-typhi salmonella, p neumococci and Escherischia coli represented 37 %, 32 %, and 15 % respectiv ely of the bacteria isolated. The mean duration between the first and last day of fever was 8.4 days. This time lapse was superior or equal to 30 days in 22 episodes (8 No), 50% of which were mycobacterioses (36 % tuberculosi s and 14 % atypic mycobacterioses). Nineteen episodes (7 %) lead to death w ithin a mean delay of 58 days. The first cause of death was atypic mycobact eriosis (26 %). Death was significantly associated with a CD4 count < 200/m m(3) and to prolongation of fever for more than 30 days. Conclusion Other than the frequently described role of tuberculosis in HIV morbidity in sub-Saharian Africa, the role of bacterial diseases, responsib le for early death, potentially severe, but curable should be underlined. T he diffusion of antibiotic treatment algorithms adapted to the principle cl inical syndromes encountered, might improve the treatment of adults infecte d by HIV consulting in sub-Saharian Africa.