Immunovirological Profile of HIV Patients with Sepsis in the Infectious Diseases Ward at the Institut des Maladies Infectieuses Professeur Daniel GAHOUMA in Libreville

Manomba Boulingui C, Ntsame Owono MM, Essomeyo Ngui Mebale M, Sibi Matotou R, Mayandza C, Moutombi Ditombi BC, Kombila UD.

Abstract

Background: HIV infection is the main comorbidity of patients hospitalized for sepsis in infectious disease departments in sub-Saharan Africa. The aim of this study is therefore to describe these clinical and immunovirological characteristics in HIV-positive patients with sepsis in Libreville.

Method: This retrospective cohort study included 105 HIV-positive patients hospitalized for sepsis (Sepsis-3 criteria) in the infectious diseases ward of the Institut de Maladies Infectieuses Professeur Daniel in Libreville. The immunovirological profile was characterized by: HIV type, WHO stage (1-4), CD4 lymphocyte count (cells/mm³), viral load (log copies/mL), antiretroviral status, and circumstances of screening. Opportunistic infections were the only focus of the study. A CD4 quartile analysis was performed. Chi-square, Mann-Whitney U, and Spearman correlation tests were used.

Results: HIV was present in 68.2% of the 154 patients with sepsis. Antiretroviral (ARV) coverage was only 31.4%. Immunosuppression was severe: median CD4 count 145 cells/mm³ (IQR: 79-255), 64.8% with CD4 count < 200 cells/mm³, and 46.7% at WHO stages 3-4. The median viral load was 5.16 log copies/mL, with 94.3% of patients having viremia ≥ 1,000 copies/mL. CD4 count was strongly correlated with WHO stage (r = - 0.447; p < 0.0001) and opportunistic infections (7% at stage 1 vs. 92% at stage 3). The circumstances of screening were primarily symptomatic (weight loss 17.1%, cough and fever 10.5%); only 12.4% underwent voluntary screening. Neither CD4 count, viral load, nor antiretroviral status were associated with in-hospital mortality (all p > 0.14).

Conclusion: The lack of association between CD4 and hospital mortality suggests that the immediate prognosis of sepsis is determined more by microbial virulence than by the underlying chronic immunosuppression.