Causes of death in HIV-positive patients under treatment in developing countries: Experience of the French Red Cross Outpatient Treatment Center at Pointe-Noire, Congo

Objectives. This study describes the causes of death of patients with HIV infection under antiretroviral treatment in a developing country. Methods. Information about patients' characteristics, HIV history, and the diseases associated with death were collected from the files of deceased patients followed at the Pointe-Noire Outpatient Treatment Center, Congo, from July, 2002 through July, 2011. Results. The study included 152 patients (sex ratio m/f 1.05). The median known duration of HIV infection of 3.5 years (range: 0.5-10). All causes for which the distinction between HIV types was available were HIV-1. At the time of screening, 16.2% of women were at stage A and 44.6% at stage C; 59% of men were at stage B. At the time of death, 5.4% of women were at stage A and 71.6% at stage C, and 28.2% of men at stage B. Treatment adherence was poor for 80.3% of patients overall. AIDS was associated with 29.6% of deaths, and another cause with 78.3%. Hemoglobin was lower than 10 g/dL in 54% of cases. Conclusion. AIDS-associated diseases remain a major cause of death, probably underestimated. Reasons are likely to include the advanced stage of HIV infection before treatment due to late screening, exposure to multiple possible opportunistic pathogens in a tropical environment, and the lack of both health facilities and sufficient treatment.