European Journal of Epidemiology

, Volume 23, Issue 3, pp 227–234

Change over time of mortality predictors after HAART initiation in a Senegalese cohort

Authors

    • Hospices Civils de Lyon, Service de Biostatistique
    • Université de Lyon
    • CNRS, UMR 5558, Laboratoire Biostatistique Santé
    • Institut de Recherche pour le Développement (IRD), UMR 145
  • Jean-François Etard
    • Institut de Recherche pour le Développement (IRD), UMR 145
  • René Ecochard
    • Hospices Civils de Lyon, Service de Biostatistique
    • Université de Lyon
    • CNRS, UMR 5558, Laboratoire Biostatistique Santé
  • Assane Diouf
    • Fann University Teaching Hospital, Regional Research and Training Centre for HIV/AIDS
  • Allé Baba Dieng
    • Fann University Teaching Hospital, Regional Research and Training Centre for HIV/AIDS
  • Vannina Cilote
    • French Ministry of Foreign Affairs
  • Ibrahima Ndiaye
    • Infectious Diseases DepartmentFann University Teaching Hospital
  • Ndèye Fatou Ngom Guèye
    • Ambulatory Care UnitFann University Teaching Hospital
  • Pape Mandoumbé Guèye
    • Military Hospital of Dakar
  • Papa Salif Sow
    • Infectious Diseases DepartmentFann University Teaching Hospital
  • Souleymane Mboup
    • Laboratory of Bacteriology and VirologyLe Dantec Teaching Hospital
  • Ibra Ndoye
    • Military Hospital of Dakar
    • Multisectorial AIDS Program
  • Eric Delaporte
    • Institut de Recherche pour le Développement (IRD), UMR 145
INFECTIOUS DISEASES

DOI: 10.1007/s10654-007-9221-3

Cite this article as:
De Beaudrap, P., Etard, J., Ecochard, R. et al. Eur J Epidemiol (2008) 23: 227. doi:10.1007/s10654-007-9221-3

Abstract

Background In 1998, Senegal was among the first sub-Saharan African countries to launch a Highly active anti-retroviral therapy (HAART) access program. Initial studies have demonstrated the feasibility and efficacy of this initiative. Analyses showed a peak of mortality short after starting HAART warranting an investigation of early and late mortality predictors. Methods 404 HIV-1-infected Senegalese adult patients were enrolled and data censored as of September 2005. Predictor effects on mortality were first examined over the whole follow-up period (median 46 months) using a Cox model and Shoenfeld residuals. Then, changes of these effects were examined separately over the early and late treatment periods; i.e., less and more than 6-month follow-up. Results During the early period, baseline body mass index and baseline total lymphocyte count were significant predictors of mortality (Hazard Ratios 0.82 [0.72–0.93] and 0.80 [0.69–0.92] per 200 cell/mm3, respectively) while baseline viral load was not significantly associated with mortality. During the late period, viro-immunological markers (baseline CD4-cell count and 6-month viral load) had the highest impact. In addition, the viral load at 6-month was a significant predictor (HR = 1.42 [1.20–1.66]). Conclusion In this cohort, impaired clinical status could explain the high early mortality rate while viro-immunological markers were rather predictors of late mortality.

Keywords

HIV HAART Mortality Prognosis Senegal Goodness-of-fit

Abbreviations

HAART

Highly active anti-retroviral therapy

ISAARV

Initiative sénégalaise d’accès aux médicaments anti-rétroviraux

BMI

Body mass index

ART

Anti-retroviral therapy

NRTI

Nucleoside reverse transcriptase inhibitors

NNRTI

Non-nucleoside reverse transcriptase inhibitors

PI

Protease inhibitor

Copyright information

© Springer Science+Business Media B.V. 2008