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


CONCLUSIONS
In this cohort, impaired clinical status could explain the high early mortality rate while viro-immunological markers were rather predictors of late mortality.
De Beaudrap
Pierre
P
Hospices Civils de Lyon, Service de Biostatistique, Lyon, F-69424, France. pierre.debeaudrap@ird.fr
Etard
Jean-François
JF
Ecochard
René
R
Diouf
Assane
A
Dieng
Allé Baba
AB
Cilote
Vannina
V
Ndiaye
Ibrahima
I
Guèye
Ndèye Fatou Ngom
NF
Guèye
Pape Mandoumbé
PM
Sow
Papa Salif
PS
Mboup
Souleymane
S
Ndoye
Ibra
I
Delaporte
Eric
E
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012675:Senegal / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors