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Incidence and determinants of mortality and morbidity following early antiretroviral therapy initiation in HIV-infected adults in West Africa
- Source :
- AIDS. 21:2483-2491
- Publication Year :
- 2007
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2007.
-
Abstract
- 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.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.In patients with pre-ART CD4 cell count200, at 200-350 and350 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.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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
Tuberculosis
Anti-HIV Agents
Immunology
Population
HIV Infections
Body Mass Index
Acquired immunodeficiency syndrome (AIDS)
Antiretroviral Therapy, Highly Active
Internal medicine
Epidemiology
medicine
Humans
Immunology and Allergy
Risk factor
education
education.field_of_study
AIDS-Related Opportunistic Infections
business.industry
Incidence (epidemiology)
Viral Load
medicine.disease
CD4 Lymphocyte Count
Surgery
Treatment Outcome
Infectious Diseases
Female
Epidemiologic Methods
business
Viral load
Cohort study
Subjects
Details
- ISSN :
- 02699370
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- AIDS
- Accession number :
- edsair.doi.dedup.....efff77f3fb0dc5350cbb5df1bf072e86