Clinical presentation, outcomes and factors associated with mortality: A prospective study from three COVID-19 referral care centres in West Africa

OBJECTIVES: The overall death toll from COVID-19 in Africa is reported to be low but there is little individual-level evidence on the severity of the disease. This study examined the clinical spectrum and outcome of patients monitored in COVID-19 care centres (CCCs) in two West-African countries. METHODS: Burkina Faso and Guinea set up referral CCCs to hospitalise all symptomatic SARS-CoV-2 carriers, regardless of the severity of their symptoms. Data collected from hospitalised patients by November 2020 are presented. RESULT: A total of 1,805 patients (64% men, median age 41 years) were admitted with COVID-19. Symptoms lasted for a median of 7 days (IQR 4-11). During hospitalisation, 443 (25%) had a SpO2 < 94% at least once, 237 (13%) received oxygen and 266 (15%) took corticosteroids. Mortality was 5% overall, and 1%, 5% and 14% in patients aged <40, 40-59 and ≥60 years, respectively. In multivariable analysis, the risk of death was higher in men (aOR 2.0, 95% CI 1.1; 3.6), people aged ≥60 years (aOR 2.9, 95% CI 1.7; 4.8) and those with chronic hypertension (aOR 2.1, 95% CI 1.2; 3.4). CONCLUSION: COVID-19 is as severe in Africa as elsewhere, and there must be more vigilance for common risk factors such as older age and hypertension

Tuberculose multifocale associée à une toxoplasmose cérébrale sur terrain immunodéprimé à VIH chez un patient immigré africain au Centre Hospitalier de Soissons, France

Dans les pays industrialisés et notamment en France, vu les moyens de prévention, dépistage précoce et prise en charge immédiate de l'infection à VIH, la survenue d'infections opportunistes ne se voit presque chez les immigrés et certaines couches socio-professionnelles défavorisées. Nous rapportons donc le cas d'un homme de 42 ans, immigré africain, hospitalisé pour syndrome infectieux dans un contexte d'altération de l'état général, VIH1 positif sous antirétroviraux depuis deux ans, arrêtés depuis quatre mois, une tuberculose pulmonaire traitée et déclarée guérie en février 2017 avec, à l'examen une lenteur à l'idéation, une fièvre à 39,6°C et un amaigrissement. Le nadir CD4 à 12/mm3, une charge virale VIH1 à 5,80log. Le scanner thoraco-abdominal et l'IRM cérébrale ont permis de visualiser des lésions intra-abdomino-thoraciques et cérébrales avant la confirmation diagnostique de la tuberculose et de la toxoplasmose. Le patient fut mis sous trithérapie antirétrovirale à quinze jours du traitement antituberculeux, puis au traitement antitoxoplasmique avec une évolution favorable

Poor outcomes among critically ill HIV-positive patients at hospital discharge and post-discharge in Guinea, Conakry: A retrospective cohort study.

IntroductionOptimal management of critically ill HIV-positive patients during hospitalization and after discharge is not fully understood. This study describes patient characteristics and outcomes of critically ill HIV-positive patients hospitalized in Conakry, Guinea between August 2017 and April 2018 at discharge and 6 months post-discharge.MethodsWe carried out a retrospective observational cohort study using routine clinical data. Analytic statistics were used to describe characteristics and outcomes.Results401 patients were hospitalized during the study period, 230 (57%) were female, median age was 36 (IQR: 28-45). At admission, 229 patients (57%) were on ART, median CD4 was 64 cells/mm3, 166 (41%) had a VL >1000 copies/ml, and 97 (24%) had interrupted treatment. 143 (36%) patients died during hospitalisation. Tuberculosis was the major cause of death for 102 (71%) patients. Of 194 patients that were followed after hospitalization a further 57 (29%) were lost-to-follow-up (LTFU) and 35 (18%) died, 31 (89%) of which had a TB diagnosis. Of all patients who survived a first hospitalisation, 194 (46%) were re-hospitalised at least once more. Amongst those LTFU, 34 (59%) occurred immediately after hospital discharge.ConclusionOutcomes for critically ill HIV-positive patients in our cohort were poor. We estimate that 1-in-3 patients remained alive and in care 6 months after their hospital admission. This study shows the burden of disease on a contemporary cohort of patients with advanced HIV in a low prevalence, resource limited setting and identifies multiple challenges in their care both during hospitalisation as well as during and after re-transitioning to ambulatory care