Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal: a 7-year cohort study.
OBJECTIVE
To evaluate survival and investigate causes of death among HIV-1 infected adults receiving HAART in Senegal.


METHODS
An observational prospective cohort.


METHODS
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).


RESULTS
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.


CONCLUSIONS
This study underlines the early mortality pattern after HAART initiation and highlights the leading role of mycobacterial infections in the causes of death.
Etard
Jean-François
JF
UMR 145 HIV/AIDS and Associated Diseases, Research Institute for Development (IRD)/University of Montpellier, 911 avenue Agropolis, 34394 Montpellier Cedex 1, France. etard@mpl.ird.fr
Ndiaye
Ibrahima
I
Thierry-Mieg
Marion
M
Guèye
Ndèye Fatou Ngom
NF
Guèye
Pape Mandoumbé
PM
Lanièce
Isabelle
I
Dieng
Allé Baba
AB
Diouf
Assane
A
Laurent
Christian
C
Mboup
Souleymane
S
Sow
Papa Salif
PS
Delaporte
Eric
E
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D003906:Developing Countries; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D015497:HIV-1; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000401:mortality; D012675:Senegal / Q000453:epidemiology
D019380:Anti-HIV Agents; D006454:Hemoglobins