Advertisement

European Journal of Epidemiology

, Volume 22, Issue 10, pp 737–744 | Cite as

Estimates of opportunistic infection incidence or death within specific CD4 strata in HIV-infected patients in Abidjan, Côte d’Ivoire: impact of alternative methods of CD4 count modelling

  • Sylvie Deuffic-Burban
  • Elena Losina
  • Bingxia Wang
  • Delphine Gabillard
  • Eugène Messou
  • Nomita Divi
  • Kenneth A. Freedberg
  • Xavier Anglaret
  • Yazdan Yazdanpanah
Infectious Diseases

Abstract

CD4 lymphocyte count is an important surrogate marker of HIV disease progression, but it is often unavailable at the time of clinical events. We analysed data from the Cotrame cohort (1999–2004) and the Trivacan Structured Treatment Interruption trial (2002–2005) to estimate the incidence of opportunistic infections and death within specific CD4 strata in HIV-infected patients receiving highly active antiretroviral therapy (HAART) in sub-Saharan Africa. We used three methods of CD4 modelling: the first assumed that CD4 cell count remained constant until the next measurement; the second assumed that it changed immediately to the level of the subsequent measurement; and the third assumed that it followed a linear function between two consecutive CD4 measurements. The cohort used in this analysis consisted of 981 patients. The incidence rates of opportunistic infections were highest in the lower CD4 strata and decreased in the higher CD4 count strata. The incidence rates of mild opportunistic infections and severe bacterial infections, however, remained high in the highest CD4 stratum. Although all confidence intervals overlapped among the three methods, the incidence rate estimates showed differences of up to 74% in the lowest CD4 stratum. Different methods of estimating CD4 counts at the time of clinical events led to minor differences in incidence rates, except in the CD4 stratum <50 cells/mm3, where the follow-up time was shorter. All of the models indicate that the overall incidence of opportunistic infections under HAART in sub-Saharan Africa is high. This suggests that prophylaxis against opportunistic infections may be needed even for patients receiving HAART.

Keywords

CD4 cell count Highly active antiretroviral therapy Opportunistic infections Sub-Saharan Africa Time-dependent variable 

Abbreviations

ANRS

Agence Nationale de Recherches sur le SIDA et les hépatites virales

CI

confidence intervals

HAART

highly active antiretroviral therapy

HIV

human immunodeficiency virus

IQR

interquartile range

NTM

non-tuberculous mycobacterium

PCP

pneumocystis jirovecii pneumonia

Notes

Acknowledgments

This study was supported by grants from the French Agence Nationale de Recherches sur le SIDA et les hépatites virales (ANRS 1286), the U.S. National Institute of Allergy and Infectious Diseases (NIAID AI058736, K23 AI0794, K24 AI062476, K25 AI50436 and CFAR P30 AI42851), and the U.S. Centers for Disease Control and Prevention (Cooperative Agreement U64/CCU 119525). We thank Lindsey L. Wolf and Caroline Sloan for administrative assistance.

References

  1. 1.
    Mellors JW, Munoz A, Giorgi JV, et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med 1997;126:946–54.PubMedGoogle Scholar
  2. 2.
    O’Brien WA, Hartigan PM, Daar ES, Simberkoff MS, Hamilton JD. Changes in plasma HIV RNA levels and CD4+ lymphocyte counts predict both response to antiretroviral therapy and therapeutic failure. VA Cooperative Study Group on AIDS. Ann Intern Med 1997;126:939–45.PubMedGoogle Scholar
  3. 3.
    Gebo KA, Gallant JE, Keruly JC, Moore RD. Absolute CD4 vs. CD4 percentage for predicting the risk of opportunistic illness in HIV infection. J Acquir Immune Defic Syndr 2004;36:1028–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Dybul M, Fauci AS, Bartlett JG, Kaplan JE, Pau AK. Guidelines for using antiretroviral agents among HIV-infected adults and adolescents. Recommendations of the Panel on Clinical Practices for Treatment of HIV. MMWR Recomm Rep 2002;51:1–55.PubMedGoogle Scholar
  5. 5.
    2001 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. HIV Clin Trials 2001;2:493–554.Google Scholar
  6. 6.
    1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. Clin Infect Dis 2000;30(Suppl 1):S29–65.Google Scholar
  7. 7.
    Anglaret X, Messou E, Ouassa T, et al. Pattern of bacterial diseases in a cohort of HIV-1 infected adults receiving cotrimoxazole prophylaxis in Abidjan, Cote d’Ivoire. AIDS 2003;17:575–84.PubMedCrossRefGoogle Scholar
  8. 8.
    Badri M, Bekker LG, Orrell C, Pitt J, Cilliers F, Wood R. Initiating highly active antiretroviral therapy in sub-Saharan Africa: an assessment of the revised World Health Organization scaling-up guidelines. AIDS 2004;18:1159–68.PubMedCrossRefGoogle Scholar
  9. 9.
    Attia A, Huët C, Anglaret X, et al. HIV-1-related morbidity in adults, Abidjan, Côte d’Ivoire: A nidus for bacterial diseases. J Acquir Immune Defic Syndr 2001;28:478–86.PubMedGoogle Scholar
  10. 10.
    Anglaret X, Chêne G, Attia A, et al. Early chemoprophylaxis with trimethoprim-sulphamethoxazole for HIV-1-infected adults in Abidjan, Côte d’Ivoire: a randomised trial. Lancet 1999;353:1463–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Dabis F, Msellati P, Meda N, et al. 6-month efficacy, tolerance, and acceptability of a short regimen of oral zidovudine to reduce vertical transmission of HIV in breastfed children in Côte d’Ivoire and Burkina Faso: a double blind placebo-controlled multicentre trial. Lancet 1999;353:786–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Seyler C, Anglaret X, Dakoury-Dogbo N, et al. Medium-term survival, morbidity and immunovirological evolution in HIV-infected adults receiving antiretroviral therapy, Abidjan, Cote d’Ivoire. Antivir Ther 2003;8:385–93.PubMedGoogle Scholar
  13. 13.
    Danel C, Moh R, Minga A, et al. CD4-guided structured antiretroviral treatment interruption strategy in HIV-infected adults in west Africa (Trivacan ANRS 1269 trial): a randomised trial. Lancet 2006;367:1981–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Losina E, Anglaret X, Yazdanpanah Y, et al. Impact of opportunistic diseases on chronic mortality in HIV-infected adults in Cote d’Ivoire. S Afr Med J 2006;96:526–9.PubMedGoogle Scholar
  15. 15.
    Mermin J, Lule J, Ekwaru JP, et al. Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda. Lancet 2004;364:1428–34.PubMedCrossRefGoogle Scholar
  16. 16.
    Miller V, Sabin CA, Phillips AN, et al. The impact of protease inhibitor-containing highly active antiretroviral therapy on progression of HIV disease and its relationship to CD4 and viral load. AIDS 2000;14:2129–36.PubMedCrossRefGoogle Scholar
  17. 17.
    Yazdanpanah Y, Chêne G, Losina E, et al. Incidence of primary opportunistic infections in two human immunodeficiency virus-infected French clinical cohorts. Int J Epidemiol 2001;30:864–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Anglaret X, Dakoury-Dogbo N, Bonard D, et al. Causes and empirical treatment of fever in HIV-infected adult outpatients, Abidjan, Cote d’Ivoire. AIDS 2002;16:909–18.PubMedCrossRefGoogle Scholar
  19. 19.
    Badri M, Wilson D, Wood R. Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: a cohort study. Lancet 2002;359:2059–64.PubMedCrossRefGoogle Scholar
  20. 20.
    Seage GR 3rd, Losina E, Goldie SJ, Paltiel AD, Kimmel AD, Freedberg KA. The relationship of preventable opportunistic infections, HIV-1 RNA, and CD4 Cell counts to chronic mortality. J Acquir Immune Defic Syndr 2002;30:421–8.PubMedGoogle Scholar
  21. 21.
    Yazdanpanah Y, Losina E, Anglaret X, et al. Clinical impact and cost-effectiveness of co-trimoxazole prophylaxis in patients living with HIV/AIDS in Côte d’Ivoire: a trial-based analysis. AIDS 2005;19:1299–308.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Sylvie Deuffic-Burban
    • 1
    • 2
  • Elena Losina
    • 3
  • Bingxia Wang
    • 3
    • 4
  • Delphine Gabillard
    • 5
  • Eugène Messou
    • 6
  • Nomita Divi
    • 4
  • Kenneth A. Freedberg
    • 3
    • 4
  • Xavier Anglaret
    • 5
  • Yazdan Yazdanpanah
    • 2
    • 7
    • 8
  1. 1.CTRS, Unité INSERM 795, Hôpital Swynghedauw, CHRU de LilleLilleFrance
  2. 2.CRESGE-LEM, CNRS UMR 8179Lille Cedex, LilleFrance
  3. 3.Departments of Biostatistics and EpidemiologyBoston University School of Public HealthBostonUSA
  4. 4.Divisions of General Medicine and Infectious Diseases and the Partners AIDS Research CenterMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  5. 5.Unité INSERM 593, Université Victor Segalen Bordeaux 2BordeauxFrance
  6. 6.Programme PACCIAbidjanIvory Coast
  7. 7.Service des Maladies Infectieuses et du VoyageurCentre Hospitalier de TourcoingTourcoingFrance
  8. 8.EA 2694, Faculté de Médecine de LilleLilleFrance

Personalised recommendations