Change over time of mortality predictors after HAART initiation in a Senegalese cohort
De Beaudrap, P.; Etard, J-François.; Ecochard, Ré.; Diouf, A.; Dieng, Aé.Baba.; Cilote, V.; Ndiaye, I.; Guèye, Nèye.Fatou.Ngom.; Guèye, P.Mandoumbé.; Sow, P.Salif.; Mboup, S.; Ndoye, I.; Delaporte, E.
European Journal of Epidemiology 23(3): 227-234
2008
ISSN/ISBN: 0393-2990 PMID: 18197359 DOI: 10.2307/40284037Document Number: 199668
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. 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. 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]). In this cohort, impaired clinical status could explain the high early mortality rate while viro-immunological markers were rather predictors of late mortality.
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