European Journal of Epidemiology

, Volume 23, Issue 3, pp 227–234 | Cite as

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

  • Pierre De Beaudrap
  • Jean-François Etard
  • René Ecochard
  • Assane Diouf
  • Allé Baba Dieng
  • Vannina Cilote
  • Ibrahima Ndiaye
  • Ndèye Fatou Ngom Guèye
  • Pape Mandoumbé Guèye
  • Papa Salif Sow
  • Souleymane Mboup
  • Ibra Ndoye
  • Eric Delaporte
INFECTIOUS DISEASES

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

Notes

Acknowledgements

The authors declare that they have no conflict of interest in relation to this article. This study was partially funded by the French “Agence Nationale de Recherche sur le SIDA et les hépatites virales B et C” (Projects 1215 and 1290), the European Union (Project B7-6211/99/005) and the association Sidaction.

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Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Pierre De Beaudrap
    • 1
    • 2
    • 3
    • 4
  • Jean-François Etard
    • 4
  • René Ecochard
    • 1
    • 2
    • 3
  • Assane Diouf
    • 5
  • Allé Baba Dieng
    • 5
  • Vannina Cilote
    • 6
  • Ibrahima Ndiaye
    • 7
  • Ndèye Fatou Ngom Guèye
    • 8
  • Pape Mandoumbé Guèye
    • 9
  • Papa Salif Sow
    • 7
  • Souleymane Mboup
    • 10
  • Ibra Ndoye
    • 9
    • 11
  • Eric Delaporte
    • 4
  1. 1.Hospices Civils de Lyon, Service de BiostatistiqueLyonFrance
  2. 2.Université de LyonVilleurbanneFrance
  3. 3.CNRS, UMR 5558, Laboratoire Biostatistique SantéPierre-BéniteFrance
  4. 4.Institut de Recherche pour le Développement (IRD), UMR 145MontpellierFrance
  5. 5.Fann University Teaching Hospital, Regional Research and Training Centre for HIV/AIDSDakarSenegal
  6. 6.French Ministry of Foreign AffairsDakarSenegal
  7. 7.Infectious Diseases DepartmentFann University Teaching HospitalDakarSenegal
  8. 8.Ambulatory Care UnitFann University Teaching HospitalDakarSenegal
  9. 9.Military Hospital of DakarDakarSenegal
  10. 10.Laboratory of Bacteriology and VirologyLe Dantec Teaching HospitalDakarSenegal
  11. 11.Multisectorial AIDS ProgramDakarSenegal

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