Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal: a 7-year cohort study

Etard, Jean‐François; Ip, Ndiaye; Thierry-Mieg, Marion; Gueye, Ndèye Fatou Ngom; Gueye, P.M.; Lanièce, Isabelle; Dieng, Allé Baba; Diouf, A.; Laurent, Christian; Mboup, Souleymane; Sow, Papa Salif; Delaporte, Eric

doi:10.1097/01.aids.0000226959.87471.01

Cited by 248 publications

(252 citation statements)

References 27 publications

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“…This higher mortality rate was similar with studies conducted in different Africa countries [5,7,[9][10][11][12][13]. The early deaths may reflect the late initiation of ART with the advanced clinical stage and severely compromised status of CD4 cell counts (<50 cells/ µl).…”

Section: Discussionsupporting

confidence: 87%

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Survival and Predictors of Mortality among Adults on Antiretroviral Therapy in Selected Public Hospitals in Harar, Eastern Ethiopia

Digaffe¹,

Seyoum²,

Oljirra³

2014

J Trop Dis

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Section: Discussionsupporting

confidence: 87%

“…This finding is supported by other studies [5,7,10,12,14]. Consequently, it is unquestionable that ART should be started (initiated) as early as possible, prior to advanced clinical stages.…”

Section: Discussionsupporting

confidence: 79%

Survival and Predictors of Mortality among Adults on Antiretroviral Therapy in Selected Public Hospitals in Harar, Eastern Ethiopia

Digaffe¹,

Seyoum²,

Oljirra³

2014

J Trop Dis

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“…Early in the roll-out of life-saving ART, incidence rates of early mortality after ART in SSA ranged from 9% to 39% 2 and were significantly higher than in developed countries. 3 Risk factors for early mortality include low CD4 T-cell count (< 50 cells/μL) 4,5 with a combined hazard ratio (HR) across studies of 2.5 (95% confidence interval [CI]: 1.9-3.2). 4 Low body mass index (BMI < 18 kg/m 2 ) has also been associated with early mortality.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial

Manabe

Worodria

Leth

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Early mortality after initiation of antiretroviral therapy (ART) occurs in 9-39% of patients in sub-Saharan Africa. A significant proportion of deaths are attributable to tuberculosis (TB). Low baseline CD4 T-cell count and low body mass index (BMI) are strongly associated with early mortality. We hypothesized that initiation of ART concurrent with presumptive anti-TB chemotherapy in high-risk patients would reduce mortality within the first 6 months by treating unrecognized TB. From October 2011 to December 2012, ART-naive, smear-negative participants with a CD4 T-cell count < 50 cells/μL and BMI < 18 kg/m 2 were randomly assigned to undergo either empiric four-drug anti-TB treatment followed 2 weeks later by efavirenz-based ART (N = 23) (ART + TB) or ART only (N = 20). This open-label, 1:1 randomized, controlled trial took place in Uganda, Mozambique, and Gabon and was stopped prematurely by the sponsor for slow recruitment. Overall, the 43 participants had a median CD4 of 22 (interquartile range [IQR]: 9-35) cells/μL and a median BMI of 17.5 (IQR: 16.6-18.0) kg/m 2 . The mortality was 14% (95% confidence interval [CI]: 5.3-27.9); two (10.0%) participants (ART-only group), and four (17.4%; ART + TB group). The associated hazard ratio (HR) for all-cause mortality was 1.6 (95% CI: 0.30-8.90). Despite limited enrollment, the study did not suggest that empiric TB treatment in severely immunosuppressed patients with low BMI decreased mortality and, had an HR in the opposite direction than expected. Notably, two participants in the ART + TB group died with autopsy-confirmed drug-induced hepatotoxicity. Improved TB diagnostics sensitive in immunosuppressed patients presenting late to care are urgently needed for more targeted interventions.

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“…On the other hand, the relatively high role of homosexuality and the use of injectable drugs in the North in the transmission of the disease. In Senegal, Etard et al [17], found a sample of 404 patients on ARV with an average age of 37 years ± 6. Studies on the ARs of ARVs performed in Mali [14], Cotonou [18] and Iran [19] noted an average age of 35 years, 41 years and 36 years, respectively, with a female predominance.…”

Section: Discussionmentioning

confidence: 99%

Adverse Drug Reactions to Antiretroviral Therapy (ART): Prospective Study in HIV Infected Adults in Sikasso (Mali)

Oumar¹,

Abdoulaye²,

Maiga³

et al. 2017

J Pharmacovigilance

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Objective: The purpose of this study was to evaluate the adverse effects of Antiretroviral Therapy (ART) in adult HIV-infected patients in decentralized setting of Sikasso, in Mali.Methods: This is a proactive study that took place from 2 January 2011 to 30 December 2012 at the Hospital of Sikasso (Department of Medicine). HIV-infected adult patients who have started ART at least 3 months before were included in this study to monitor the laboratory and clinical Adverse Drug Reactions (ADR) for at least 6 months. The WHO classification of adverse drug reactions has been used to investigate the causality of antiretrovirals.Results: Women were the most represented with 58% of the cases. The most represented age range was 26-47 years with 73.6%. Of the 178 patients enrolled, 61.2% had an ADR. ADR were neurological (40.4%), digestive (35.8%), cutaneous (18.3%) and hematological (5.5%). Stavudine was the most incriminated molecule, in 24.8% of the cases. The WHO grade 4 classification of ART toxicity was represented in 3.4% of the cases. The WHO causality score of "certain" was found in 29.8% of the cases. Conclusion:Adverse effects of Antiretrovirals are frequent and could be life-threatening in short and long terms. Regular follow-up of patients receiving these triple therapies, and the associated complications, is essential. We recommend active surveillance of antiretroviral therapy to strengthen Pharmacovigilance in Mali.

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Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal: a 7-year cohort study

Abstract: This study underlines the early mortality pattern after HAART initiation and highlights the leading role of mycobacterial infections in the causes of death.

Cited by 248 publications

References 27 publications

Survival and Predictors of Mortality among Adults on Antiretroviral Therapy in Selected Public Hospitals in Harar, Eastern Ethiopia

Survival and Predictors of Mortality among Adults on Antiretroviral Therapy in Selected Public Hospitals in Harar, Eastern Ethiopia

Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial

Adverse Drug Reactions to Antiretroviral Therapy (ART): Prospective Study in HIV Infected Adults in Sikasso (Mali)

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