Facteurs associés à la létalité chez les patients hospitalisés pour le VIH avancé

CONTEXT: A unit supported by Médecins Sans Frontières (MSF) cares for patients with advanced HIV at Donka National Hospital, Conakry, Guinea. OBJECTIVE: To determine the factors associated with the occurrence of death in patients hospitalised in the unit between 2017 and 2021. DESIGN: This was a retrospective analysis of routine data from patients hospitalised with advanced HIV. RESULTS: A total of 3,718 patients were included, with a median age of 40 years (IQR 33–51), of whom 2,241 (60.3%) were women. The mean mortality rate was 33.6% (n = 1,240), down from 40% in 2017 to 29% in 2021, but this was not statistically significant. The period most at risk of death was the first 25 days of hospitalisation. Among these patients, TB (43.8%) and toxoplasmosis (11.4%) were the most frequent diagnoses. After multivariate analysis using Cox regression, the factors associated with death were age 25–49 years (adjusted hazard ratio [aHR] 1.60; P = 0.002) or ≥50 years (aHR 1.80; P < 0.001), the presence of respiratory (aHR 1.23; P = 0.001) or abdominal symptoms (aHR 1.26; P < 0.001) and readmission (aHR 0.54; P < 0.001). CONCLUSION: Patients aged 25–49 years or older, or those presenting with respiratory or abdominal signs require increased surveillance, as they are at the greatest risk of dying from the disease, especially during the first 25 days of hospitalisation.