[Causes and characteristics of patient death under ARV at the Dermatology-Venereology Department of the Donka National Hospital, GUINEA].

Introduction: The antiretroviral treatments led to a spectacular reduction of morbidity and mortality of HIV-infected patients, transforming it into a chronic infection. HIV infection remains potentially lethal and requires a long term treatment to obtain an immunological and virological control. The goal of this work was to describe the characteristics of the deaths during the ARV treatment.

Materials And Method: We led a descriptive retrospective study of a 4 year period, from July 2004 to August 2007 which looked at 429 patient under ARV followed in the dermatology - venereology department of the Donka national hospital and whose death during hospitalization occurred for the study period. We excluded the patients who suffered loss of sight or who died during the ARV treatment period.

Results: On 429 included patients, recorded death rate was of 27,7%. The mean age of included patients was 42 ± 6.5 years old. Patients at the stage 3 and 4 of the WHO classification recorded the greatest number of death. There was no patient at stage I. More half of the patients were immunosuppressed with a count of CD4 < 200/mm3. In our study 66 patients died with a rate of CD4 < 200/mm3 21 patients with a rate of CD4 ranging between 200 and 499 or 17,6%. Only one patient had a rate of CD4 > 500/mm3 while 31 other patients did not have a CD4 at the time of the death. We recorded 57 deaths in the first 6 months of HAART (among which 32 occurred within the first 3 months) and 24 after. The leading causes of death were tuberculosis (47,05%) including 64,28% of pulmonary localization and 35,71% of extrapulmonary localization, followed by cerebral toxoplasmosis (19,62%) and Kaposi disease (15,12%). The other causes of death found were hepatitis B (4,20%) and neuro-meningeal cryptococcosis (2,52%). A socio-economic unstable situation was found at half of the patients For 14 case the cause of death remained unknown. There no was death due to side effects of the ARV therapy. 89,1% of the patients deceased were under protocol 2 INTI + 1 INNTI which represents the layout of first line in our country.

Conclusion: The mortality of the infection by HIV remains high in spite of the introduction of ARV treatment into our service. The patients who passed away were mainly characterized by a low level of CD4 and a very advanced stage of the evolution of the infection to the initiation of the ARV. The leading causes of death were opportunist infections. An early tracking of the infection by HIV and an early and optimal assumption of responsibility of the opportunist infections could contribute to reverse the tendencies in Guinea.