title: Incidence and determinants of mortality and morbidity following early antiretroviral therapy initiation in HIV-infected adults in West Africa.
abstract: OBJECTIVE
  To estimate the incidence and risk factors of mortality and severe morbidity during the first months following antiretroviral therapy (ART) initiation in West African adults.
  
  
  METHODS
  A cohort study in Abidjan in which 792 adults started ART with a median CD4 cell count of 252 cells/mul and were followed for a median of 8 months. Severe morbidity was defined as all World Health Organization stage 3 or 4-defining morbidity events other than oral candidiasis.
  
  
  RESULTS
  In patients with pre-ART CD4 cell count < 200, at 200-350 and > 350 cells/mul, incidence of mortality was 5.0 [95% confidence interval (CI), 2.6-8.7], 1.7 (95% CI, 0.6-3.8) and 0.0 (95% CI, 0.0-3.4]/100 person-years, and incidence of severe morbidity was 13.3 (95% CI, 9.0-19.1), 9.5 (95% CI, 6.2-12.9) and 7.9 (95% CI, 3.4-15.5)/100 person-years, respectively. The most frequent diseases were invasive bacterial diseases (32/65 episodes, 49%) and tuberculosis (25/65 episodes, 38%). Both diseases followed the same curve of decreasing incidence over time. Patients who experienced severe morbidity had higher risks of mortality, virological failure and immunological failure. Other independent risk factors for mortality and/or severe morbidity were: at baseline, high viral load, advanced clinical stage, past history of tuberculosis, low BMI, low haemoglobin and low CD4 cell count; during follow-up: low CD4 cell count and persistently detectable viral load.
  
  
  CONCLUSIONS
  These data give new arguments to reinforce the hypothesis that, in this region, ART should be started before the CD4 cell count drops below 350 cells/mul. Further studies should assess whether patients with low BMI, low haemoglobin, high viral load or past history of tuberculosis should start ART earlier.
authors.affiliation: Trivacan ANRS 1269 study group, Abidjan, France.
authors.forename: Raoul
authors.initials: R
authors.lastname: Moh
authors.forename: Christine
authors.initials: C
authors.lastname: Danel
authors.forename: Eugène
authors.initials: E
authors.lastname: Messou
authors.forename: Timothée
authors.initials: T
authors.lastname: Ouassa
authors.forename: Delphine
authors.initials: D
authors.lastname: Gabillard
authors.forename: Amani
authors.initials: A
authors.lastname: Anzian
authors.forename: Yao
authors.initials: Y
authors.lastname: Abo
authors.forename: Roger
authors.initials: R
authors.lastname: Salamon
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bissagnene
authors.forename: Catherine
authors.initials: C
authors.lastname: Seyler
authors.forename: Serge
authors.initials: S
authors.lastname: Eholié
authors.forename: Xavier
authors.initials: X
authors.lastname: Anglaret
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000821:virology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents