The present and future course of the AIDS epidemic in Côte d'Ivoire.

The 1st application of the WHO AIDS projection model was used to generate current and short-term projection of AIDS cases in the Ivory Coast based on a 1989 national seroepidemiological survey of HIV prevalence. A brief population profile is presented followed by a discussion of HIV-infected adults estimates estimation of annual cohorts of infants born to HIV-infected mothers and modeling assumptions and results. The results indicate a rise in HIV-related morbidity and mortality among adults particularly those in their most productive years and children. Cumulative AIDS cases for adults 15-49 years were 15000 and children 0-4 years were 10000 up to 1989 and 40% of patients in 2 of the largest hospitals in Abidjan were HIV-infected. The projection of cumulative cases will rise to 130000 by 1994 and an additional 12% are estimated to be >or= 50 years of age. If the progression from HIV 2 to AIDS is slower the figure rises to an additional 15% above the total aged 15-49. 5-14 year olds may contribute another 2-3% to the total. 11000 adults had died by 1989 and another 72000 are projected to die before 1994. 8000 children had died to AIDS by 1989 and 35000 out of 87000 HIV-infected are expected to die by 1994. Reported cases to estimated cases are in a ratio of 1:619 for adults and 1:160 for children. Projections were based on the HIV prevalence survey which may not be truly representative since Abidjan was excluded (it has 33% of the urban population). The sample also was not stratified to weight higher than average risk groups and contained other methodological bias which means HIV infection may have been undersampled. Estimates may also be conservative because of the use of AIDS survival rates for the US when survival in sub-Saharan Africa may be shorter. HIV infection is assumed to have peaked in 1989 and the estimates may be conservative for reproductive-aged women and infants and children. It is hoped that future revised projections will be based on more data on the natural history of HIV infection. The 1989 survey established that HIV-1 prevalence of 15-49 year olds was 4.2% in urban areas and 3.2% in rural areas. HIV-2 was 2.4% in urban and 1.6% in rural areas. The assumption was made that variance of a cluster sample can be approximated by standard statistical methods for the variance of a simple random sample. Cumulative progression rates from HIV to AIDS were assumed to be 2% after 2 years 20% after 5 years 50% after 10 years and 37.5% after 15 years. AIDS survival rates were assumed to be 50% after 1 year 20% after 2 years 50% after 3 years and 0 after 4 years. Perinatal transmission was assumed to be 30% for HIV-1 and 15% for HIV-2.