Study of Biological Parameters in Patients with Advanced HIV Infection in Donka

Abstract

Introduction: Human Immunodeficiency Virus (HIV) infection remains a major public health problem, particularly in sub-Saharan Africa. Despite expanded access to antiretroviral therapy (ART), many patients are still admitted at an advanced stage of the disease, characterized by severe immunosuppression and high morbidity. In this context, the evaluation of biological parameters is an essential tool for the monitoring and management of patients with advanced HIV disease (AHD). Methodology: A retrospective and analytical study was conducted at the Care, Training, and Research Unit (CTRU) of Donka National Hospital over a four-year period (2016-2020). All patients aged 15 years or older hospitalized for advanced HIV infection (CD4 < 200 cells/mm³ or clinical stage III/IV according to the WHO) were included. Sociodemographic, clinical, and biological data were collected and analyzed using Epi Info 7.2.2.6 software, with a significance threshold set at p < 0.05. Proportions were compared using the chi-square (χ²) test, while means were compared using analysis of variance (ANOVA). Results: A total of 2,236 HIV-infected patients were hospitalized during the study period. Of these, 1,861 (83.22%) were over 15 years of age, in accordance with the inclusion criteria, and were included in the analysis. The study population was predominantly female, with 1,144 women (61.47%) compared to 717 men (38.53%), representing a male-to-female ratio of 0.6. The most represented age group was 35 to 44 years old (590 patients, or 31.70%). The average age of participants was 38.69 ± 12.07 years, ranging from 15 to 79 years. HIV-1 accounted for 99.2% of cases. Nearly half of patients (48.1%) had a CD4 count < 50 cells/mm³ and 89.6% had a detectable viral load. Severe anemia (< 8 g/dL) was observed in 47.6% of patients, leukopenia in 45.1%, and neutropenia in 50%. Renal failure (creatinine > 150 µmol/L) was observed in 44.4% of cases. Mortality was significantly associated with WHO stage IV (p = 0.00002) and a CD4 count < 50 cells/mm³ (p = 0.00003). Conclusion: This study highlights the high frequency of biological abnormalities in patients admitted to the USFR Donka in the advanced stages of HIV infection, characterized by profound immunodeficiency, severe cytopenias, and largely uncontrolled viral load. The major prognostic factors for mortality identified clinical stage IV and CD4 count < 50 cells/mm³ confirm the severity of these advanced forms.