| Titre : | Change over time of mortality predictors after HAART initiation in a Senegalese cohort. (2008) |
| Auteurs : | Pierre DE BEAUDRAP ; Allé BABA DIENG ; Vannina CILOTE ; Eric DELAPORTE ; Assane DIOUF ; René ECOCHARD ; Jean-Francois ETARD ; Ndèye FATOU NGOM GUEYE ; Pape MANDOUMBE GUEYE ; Souleymane MBOUP ; Ibrahima NDIAYE ; Ibra NDOYE ; Papa SALIF SOW ; Cnrs. Pierre Bénite. FRA ; Fann University Teaching Hospital. Regional Research and Training Centre for Hiv Aids. Dakar. SEN ; Infectious Diseases Department. Fann University Teaching Hospital. Dakar. SEN ; Military Hospital of Dakar. Dakar. SEN ; Université de Lyon. Université Lyon 1. Villeurbanne. FRA |
| Type de document : | Article |
| Dans : | European journal of epidemiology (vol. 23, n° 3, 2008) |
| Pagination : | 227-234 |
| Langues: | Anglais |
| Mots-clés : | Changement ; Mortalité ; Epidémiologie ; Médicament antirétroviral ; Médicament antiviral ; Thérapeutique ; Initiation ; Sénégal ; Sida ; VIH ; Pronostic ; Homme ; Afrique ; Virose ; Infection ; Rétrovirus ; Virus ; Immunopathologie |
| Résumé : | [BDSP. Notice produite par INIST-CNRS 8DEnnR0x. Diffusion soumise à autorisation]. 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]). Conclusion : 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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