title: Change over time of mortality predictors after HAART initiation in a Senegalese cohort.
abstract: 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.
authors.affiliation: Hospices Civils de Lyon, Service de Biostatistique, Lyon, F-69424, France. pierre.debeaudrap@ird.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: De Beaudrap
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etard
authors.forename: René
authors.initials: R
authors.lastname: Ecochard
authors.forename: Assane
authors.initials: A
authors.lastname: Diouf
authors.forename: Allé Baba
authors.initials: AB
authors.lastname: Dieng
authors.forename: Vannina
authors.initials: V
authors.lastname: Cilote
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Ndiaye
authors.forename: Ndèye Fatou Ngom
authors.initials: NF
authors.lastname: Guèye
authors.forename: Pape Mandoumbé
authors.initials: PM
authors.lastname: Guèye
authors.forename: Papa Salif
authors.initials: PS
authors.lastname: Sow
authors.forename: Souleymane
authors.initials: S
authors.lastname: Mboup
authors.forename: Ibra
authors.initials: I
authors.lastname: Ndoye
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
mesh_terms: 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