Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal: A 7-year cohort study

UMR 145 HIV/AIDS and Associated Diseases, Research Institute for Development (IRD)/University of Montpellier, 911 avenue Agropolis, 34394 Montpellier Cedex 1, France.
AIDS (Impact Factor: 5.55). 06/2006; 20(8):1181-9. DOI: 10.1097/01.aids.0000226959.87471.01
Source: PubMed


To evaluate survival and investigate causes of death among HIV-1 infected adults receiving HAART in Senegal.
An observational prospective cohort.
Mortality was assessed in the first patients enrolled between August 1998 and April 2002 in the Senegalese antiretroviral drug access initiative. First-line regimen combined two nucleoside reverse transcriptase inhibitors and either a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor. The most likely causes of death were ascertained through medical records or post-mortem interviews (verbal autopsy).
Four hundred and four patients (54.7% women) were enrolled in the study and were followed for a median of 46 months (interquartile range: 32-57 months) after HAART initiation. At baseline, 5% were antiretroviral therapy (ART) non-naive, 39 and 55% were respectively at CDC stage B and C, median age, CD4 cell count and viral load were 37 years, 128 cells/microl and 5.2 log cp/ml, respectively. Ninety-three patients died during follow-up and the overall incidence rate of death was 6.3/100 person-years [95% confidence interval (CI), 5.2-7.7]. During the first year after HAART initiation, 47 patients died and seven were lost to follow-up, yielding to a probability of dying of 11.7% (95% CI, 8.9-15.3%). The death rate, which was highest during the first year after HAART initiation, decreased with time yielding a cumulative probability of dying of 17.4% (95% CI, 13.9-21.5%) and 24.6% (95% CI, 20.4-29.4%) at 2 and 5 years. Causes of death were ascertained in 76 deaths. Mycobacterial infections, neurotropic infections and septicaemia were the most frequent likely causes of death.
This study underlines the early mortality pattern after HAART initiation and highlights the leading role of mycobacterial infections in the causes of death.

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    • "This encapsulated yeast is found in soil contaminated with bird droppings particularly from pigeons and chickens, usually inhaled through lungs and remain dormant for many years. Reactivation, which occurs primarily among immunosuppressed individual such as people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLHAs), leads to infection and most of which is meningitis.[2] CM is a significant cause of morbidity and mortality among PLHAs world-wide.[3456] Cryptococcus infect an estimated 1 million people and results in approximately 625,000 deaths annually.[7] "
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    ABSTRACT: Objective: Cryptococcal meningitis (CM) caused by encapsulated opportunistic yeast Cryptococcus neoformans is an important contributor to morbidity and mortality in people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLHAs). Early diagnosis of such patients is the key to their therapeutic success. A retrospective study was conducted to evaluate the clinical features, laboratory findings, and prevalence of CM among hospitalized PLHAs in a tertiary care setting. Materials and methods: A total of 112 clinically diagnosed CM patients were subjected to cerebrospinal fluid analysis and tests for human immunodeficiency virus antibodies by the standard laboratory operating procedures. Results: Out of 112, 16 showed a definite diagnosis of C. neoformans with the prevalence of 14.3%. Males in the age group of 21-40 years were most commonly affected than females. The clinical manifestations observed were fever and headache (100%), followed by altered sensorium (93.7%), neck stiffness (75%), and vomiting (62.5%). Overall, Cluster of differentiation 4 (CD4) T-lymphocytes count was <100 cells/μl except 1 case in which the CD4 T-lymphocytes count was 137 cells/μl. No concomitant cryptococcal and tubercular meningitis case was detected. All 16 patients responded initially to induction therapy of IV amphotericin B 1 mg/kg and fluconazole 800 mg daily for 2 weeks. Subsequently, 4 (25%) patients were lost for follow-up and 2 (12.5%) patients expired during their hospital stay. Conclusion: As the clinical and radiological pictures of CM are often non-pointing, routine mycological evaluation is necessary for early definite diagnosis and subsequent initiation of appropriate therapy as the majority of patients respond well to treatment if started early.
    07/2014; 5(2):324-8. DOI:10.4103/0976-9668.136176
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    • "Even though ART is loosely referred to as a lifelong treatment, clinical, immunological and virological outcome measures differ among patients on highly active ART (HAART), with differences reported within and across cohorts.1–6 Mortality is among the ART-outcome variables that have been studied extensively, and rates of up to 30% have been reported during the first year of treatment in some sub-Saharan settings.1–4 Mortality among HIV/ART patients has also occurred in other parts of the world, though at rates lower than that reported in the sub-Saharan Africa region.5,6 "
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    ABSTRACT: CD4 T lymphocytes remain the surrogate measure for monitoring HIV progress in resource-limited settings. The absolute CD4 cell counts form the basis for antiretroviral therapy (ART) initiation and monitoring among HIV-infected adults. However, the rate of CD4 cell change differs among patients, and the factors responsible are inadequately documented. This study investigated the relationship between HIV severity and ART outcomes among ART-naïve Ugandans, with the primary outcome of complete immunological recovery among patients of different baseline CD4 counts. Patients' records at two HIV/ART sites - the Joint Clinic Research Centre (JCRC) in the Kampala region and Mbarara Hospital in Western Uganda - were reviewed. Records of 426 patients - 68.3% female and 63.2% from JCRC - who initiated ART between 2002 and 2007 were included. HIV severity was based on baseline CD4 cell counts, with low counts considered as severe immunosuppression, while attaining 418 CD4 cells/μL signified complete immunological recovery. Incidence rates of complete immunological recovery were calculated for, and compared between baseline CD4 cell categories: <50 with ≥50, <100 with ≥100, <200 with ≥200, and ≥200 with ≥250 cells/μL. The incidence of complete immunological recovery was 158 during 791.9 person-years of observation, and patients with baseline CD4 ≥ 200 cells/μL reached the end point of immunological recovery 1.89 times faster than the patients with baseline CD4 < 200 cells/μL. CD4 cell change also differed by time, sex, and site, with a faster increase observed during the first year of treatment. CD4 cell increase was faster among females, and among patients from Mbarara. Initiating ART at an advanced HIV stage was the main reason for poor immunological recovery among Ugandans. Earlier ART initiation might lead to better immunological responses.
    HIV/AIDS - Research and Palliative Care 12/2013; 5:309-319. DOI:10.2147/HIV.S50614
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    • "Most patients registered at OPCs already with advanced stages of HIV infection. These findings were similar to reports from other resource-limited settings, including sub-Saharan Africa [11], [12], [13], [14], [15], [16], [17], [18], China [19], India [20], Thailand [21] and Haiti [22]. Even after several years of experience managing the national ART program, late presentation remains problematic in Vietnam as it does in many other countries [12], [20]. "
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    ABSTRACT: Vietnam has significantly scaled up its national antiretroviral therapy (ART) program since 2005. With the aim of improving Vietnam's national ART program, we conducted an outcome evaluation of the first five years of the program in this concentrated HIV epidemic where the majority of persons enrolled in HIV care and treatment services are people who inject drugs (PWID). The results of this evaluation may have relevance for other national ART programs with significant PWID populations. Retrospective cohort analysis of patients at 30 clinics randomly selected with probability proportional to size among 120 clinics with at least 50 patients on ART. Charts of patients whose ART initiation was at least 6 months prior to the study date were abstracted. Depending on clinic size, either all charts or a random sample of 300 charts were selected. Analyses were limited to treatment-naïve patients. Multiple imputations were used for missing data. Of 7,587 patient charts sampled, 6,875 were those of treatment-naïve patients (74.4% male, 95% confidence interval [CI]: 72.4-76.5, median age 30, interquartile range [IQR]: 26-34, 62.0% reported a history of intravenous drug use, CI: 58.6-65.3). Median baseline CD4 cell count was 78 cells/mm (IQR: 30-162) and 30.4% (CI: 25.8-35.1) of patients were at WHO stage IV. The majority of patients started d4T/3TC/NVP (74.3%) or d4T/3TC/EFV (18.6%). Retention rates after 6, 12, 24, and 36 months were 88.4% (CI: 86.8-89.9), 84.0% (CI: 81.8-86.0), 78.8% (CI: 75.7-81.6), and 74.6% (CI: 69.6-79.0). Median CD4 cell count gains after 6, 12, 24, and 36 months were 94 (IQR: 45-153), 142 (IQR: 78-217), 213 (IQR: 120-329), and 254 (IQR: 135-391) cells/mm. Patients who were PWID showed significantly poorer retention. The study showed good retention and immunological response to ART among a predominantly PWID group of patients despite advanced HIV infections at baseline.
    PLoS ONE 02/2013; 8(2):e55750. DOI:10.1371/journal.pone.0055750 · 3.23 Impact Factor
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