title: Incidence of Severe Neutropenia in HIV-Infected People Starting Antiretroviral Therapy in West Africa.
abstract: BACKGROUND
  In sub-Saharan Africa, antiretroviral therapy (ART) including drugs with potential toxicity such as Zidovudine (ZDV) are routinely prescribed. This study aimed at estimating the incidence of severe neutropenia and associated factors after ART initiation in five West African countries.
  
  
  METHODS
  A retrospective cohort analysis was conducted within the international epidemiologic database to evaluate AIDS (IeDEA) collaboration in West Africa. All HIV-infected adults, initiating ART between 2002 and 2014, with a baseline and at least one follow-up absolute neutrophil count (ANC) measurement were eligible. Incidence of severe neutropenia (ANC <750 cells/mm3) was estimated with 95% confidence interval (CI) according to age, gender, HIV clinic, hemoglobin, CD4 count, clinical stage, and ART duration. A Cox proportional hazard model was used to identify factors associated with severe neutropenia, expressed with their adjusted hazard ratios (aHR).
  
  
  RESULTS
  Between 2002 and 2014, 9,426 HIV-infected adults were enrolled. The crude incidence rate of a first severe neutropenia was 9.1 per 100 person-years (95% CI: 8.6-9.8). Factors associated with severe neutropenia were exposure to ZDV <6 months (aHR = 2.2; 95% CI: 1.8-2.6), ≥6-12 months (aHR = 2.1; 95% CI: 1.6-2.8) and ≥12 months (aHR = 1.6; 95% CI: 1.2-2.2) [Ref. no ZDV exposure], CD4 count <350 cells/mm3 (aHR = 1.3; 95% CI: 1.1-1.5) and advanced clinical stage at ART initiation (aHR = 1.2; 95% CI: 1.0-1.4).
  
  
  CONCLUSIONS
  The incidence of severe neutropenia after ART initiation in West Africa is high and associated with ZDV exposure and advanced HIV disease. In this context, efforts are needed to scale-up access to less toxic first-line ART drugs and to promote early ART initiation.
authors.affiliation: Bordeaux University, School of Public Health (ISPED), Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.|INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.
authors.forename: Charline
authors.initials: C
authors.lastname: Leroi
authors.affiliation: Bordeaux University, School of Public Health (ISPED), Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.|INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Balestre
authors.affiliation: Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire.|Centre de Prise en charge de Recherche et de Formation, Hôpital Yopougon Attié, Abidjan, Côte d'Ivoire.
authors.forename: Eugene
authors.initials: E
authors.lastname: Messou
authors.affiliation: Centre Médical de Suivi de Donneurs de Sang /CNTS/PRIMO-CI, Abidjan, Cote d'Ivoire.
authors.forename: Albert
authors.initials: A
authors.lastname: Minga
authors.affiliation: Département de maladies infectieuses, CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso.
authors.forename: Adrien
authors.initials: A
authors.lastname: Sawadogo
authors.affiliation: Service de Médecine interne, CHU Yalgado Ouedraogo (CHU-YO), Ouagadougou, Burkina Faso.
authors.forename: Joseph
authors.initials: J
authors.lastname: Drabo
authors.affiliation: Service d'Hépato-Gastro-Entérologie, Hôpital Gabriel Touré, Bamako, Mali.
authors.forename: Moussa
authors.initials: M
authors.lastname: Maiga
authors.affiliation: Centre de Prise en Charge des Personnes vivant avec le VIH, CNHU, Cotonou, Benin.
authors.forename: Marcel
authors.initials: M
authors.lastname: Zannou
authors.affiliation: Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal.
authors.forename: Moussa
authors.initials: M
authors.lastname: Seydi
authors.affiliation: Bordeaux University, School of Public Health (ISPED), Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.|INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.affiliation: Bordeaux University, School of Public Health (ISPED), Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.|INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Jaquet
mesh_terms: D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D008297:Male; D009503:Neutropenia / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015215:Zidovudine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine