Background: The causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes\nare poorly documented in sub-Saharan Africa. We aimed to describe severe morbidity among HIV-infected patients after\nART initiation, based on data from an active surveillance system established within a network of specialized care facilities\nin West African cities.\nMethods: Within the International epidemiological Database to Evaluate AIDS (IeDEA) - West Africa collaboration,\nwe conducted a prospective, multicenter data collection that involved two facilities in Abidjan, C�´te dâ��Ivoire and\none in Cotonou, Benin. Among HIV-infected adults receiving ART, events were recorded using a standardized form.\nA simple case-definition of severe morbidity (death, hospitalization, fever > 38�°5C, Karnofsky index < 70%) was used\nat any patient contact point. Then a physician confirmed and classified the event as WHO stage 3 or 4 according\nto the WHO clinical classification or as degree 3 or 4 of the ANRS scale.\nResults: From December 2009 to December 2011, 978 adults (71% women, median age 39 years) presented with\n1449 severe events. The main diagnoses were: non-AIDS-defining infections (33%), AIDS-defining illnesses (33%),\nsuspected adverse drug reactions (7%), other illnesses (4%) and syndromic diagnoses (16%). The most common\nspecific diagnoses were: malaria (25%), pneumonia (13%) and tuberculosis (8%). The diagnoses were reported as\nsyndromic in one out of five events recorded during this study.\nConclusions: This study highlights the ongoing importance of conventional infectious diseases among severe\nmorbid events occurring in patients on ART in ambulatory HIV care facilities in West Africa. Meanwhile, additional\nstudies are needed due to the undiagnosed aspect of severe morbidity in substantial proportion.
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