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

ArticleinAIDS 20(8):1181-9 · June 2006with16 Reads
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.
    • "We found that anaemia was consistent with increasing disease progression of HIV as per recommendations of the Center for Disease Control (CDC)272829. Similarly, anaemia at the time of HAART initiation has been associated with HIV disease progression and mortality [6,89101112. This association has been linked to an increasing viral burden as HIV disease progresses and may cause anaemia through increased cytokine-mediated myelosuppression. "
    [Show abstract] [Hide abstract] ABSTRACT: Aim. We determined the prevalence of anaemia and evaluated markers of iron homeostasis in a cohort of HIV patients. Methods. A comparative cross-sectional study on 319 participants was carried out at the Tamale Teaching Hospital from July 2013 to December 2013, 219 patients on HAART (designated On-HAART) and 100 HAART-naive patients. Data gathered include sociodemography, clinical history, and selected laboratory assays. Results. Prevalence of anaemia was 23.8%. On-HAART participants had higher CD4/CD3 lymphocyte counts, Hb, HCT/PCV, MCV, MCH, iron, ferritin, and TSAT ( P < 0.05 ). Hb, iron, ferritin, and TSAT decreased from grade 1 to grade 3 anaemia and CD4/CD3 lymphocyte count was lowest in grade 3 anaemia ( P < 0.05 ). Iron ( P = 0.0072 ) decreased with disease severity whilst transferrin ( P = 0.0143 ) and TIBC ( P = 0.0143 ) increased with disease severity. Seventy-six (23.8%) participants fulfilled the criteria for anaemia, 86 (26.9%) for iron deficiency, 41 (12.8%) for iron deficiency anaemia, and 17 (5.3%) for iron overload. The frequency of anaemia was higher amongst participants not on HAART (OR 2.6 for grade 1 anaemia; OR 3.0 for grade 3 anaemia). Conclusion. In this study population, HIV-associated anaemia is common and is related to HAART status and disease progression. HIV itself is the most important cause of anaemia and treatment of HIV should be a priority compared to iron supplementation.
    Full-text · Article · Mar 2016
    • "It is reportedly common among patients with immunosuppression and could also be the initial manifestation of HIV infection [6] . Cryptococcal meningitis is reportedly a leading contributor to early mortality in the first few months of antiretroviral therapy, accounting for up to 20% of all deaths [7] [8] . A high mortality rate due to CM has been reported among patients recently initiated on ART despite an expanding access in South Africa [9]. "
    Full-text · Article · Jan 2016
    • "The impact of NTM infection on LAM test accuracy also depends on NTM prevalence among HIV-positive patients. The burden of TB is the leading cause of morbidity and mortality in HIV patients [22,23]. A recent autopsy study among HIV positive individuals in South Africa found M. tuberculosis in 26/39 (67%) of the mycobacterial cases and comparatively 2/39 (5%) with NTM [24] . "
    [Show abstract] [Hide abstract] ABSTRACT: Background The urine lipoarabinomannan (LAM) strip test has been suggested as a new point-of-care test for active tuberculosis (TB) among human immunodeficiency virus (HIV) infected individuals. It has been questioned if infections with nontuberculous mycobacteria (NTM) affect assay specificity. We set forth to investigate if the test detects LAM in urine from a Danish cystic fibrosis (CF) population characterized by a high NTM prevalence and negligible TB exposure.Method Patients followed at the Copenhagen CF Center were comprehensively screened for pulmonary NTM infection between May 2012 and December 2013. Urine samples were tested for LAM using the 2013 DetermineTM TB LAM Ag strip test.ResultsThree-hundred and six patients had a total of 3,322 respiratory samples cultured for NTM and 198 had urine collected (65%). A total of 23/198 (12%) had active pulmonary NTM infection. None had active TB. The TB-LAM test had an overall positive rate of 2.5% applying a grade 2 cut-point as positivity threshold, increasing to 10.6% (21/198) if a grade 1 cut-point was applied. Among patients with NTM infection 2/23 (8.7%) had a positive LAM test result at the grade 2 cut-point and 9/23 (39.1%) at the grade 1 cut -point. Test specificity for NTM diagnosis was 98.3% and 93.1 for grade 2 and 1 cut-point respectively.Conclusions This is the first study to assess urine LAM detection in patients with confirmed NTM infection. The study demonstrated low cross-reactivity due to NTM infection when using the recommended grade 2 cut-point as positivity threshold. This is reassuring in regards to interpretation of the LAM test for TB diagnosis in a TB prevalent setting. The test was not found suitable for NTM detection among patients with CF.
    Full-text · Article · Dec 2014
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