RÉSUMÉ
Since the pathogen ecology differs between Caribbean regions, specific differences in the most frequent clinical presentations of acquired immunodeficiency syndrome (AIDS) may be expected. We therefore conducted the present retrospective cohort study in order to describe the main AIDS-defining events in Guadeloupe and to compare them with those observed in Metropolitan France and in French Guiana. We discuss the local pathogen ecology, the diagnostic limitations of hospitals in overseas territories and the drivers of the epidemic.
Sujet(s)
Infections opportunistes liées au SIDA/épidémiologie , Syndrome d'immunodéficience acquise/épidémiologie , Épidémies , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Comparaison interculturelle , Femelle , France/épidémiologie , Guyane française/épidémiologie , Guadeloupe/épidémiologie , Humains , Mâle , Déclaration obligatoire , Adulte d'âge moyen , Surveillance de la population , Études rétrospectives , Comportement sexuel , Population urbaine , Jeune adulteRÉSUMÉ
A retrospective cohort study was conducted to determine the incidence and the predictive factors of depression in a cohort of 2737 HIV/AIDS-infected patients in Guadeloupe followed for a total of 8402 patient-years. The incidence rate of first observed depression was 2.2 per 100 person-years (95% confidence interval [CI], 1.9-2.6). A single failure Cox proportional hazards model showed that the 1997-2000 inclusion period (hazard ratio [HR] = 1.60; 95% CI = 1.10-2.40;p = 0.01), the 2001-2009 inclusion period (HR = 1.50; 95% CI = 1.02-2.40;p = 0.04), the more advanced CDC stage (HR = 2.30; 95% CI = 1.30-3.10;p = 0.000) and the annual frequency of visits > 10 (HR = 2.30; 95% CI = 1.70-3.30;p = 0.000) were associated with an increased risk of depression. Incidence of depression in this HIV cohort was high and the hazard function showed three peaks of depression (2, 7 and 12 years). Physicians should be vigilant to psychological distress throughout life with HIV.