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CD4-Specific Mortality and Tuberculosis Rates in Untreated HIV-Infected Adults in West Africa

This study analyzes CD4-specific mortality, tuberculosis incidence, and ART initiation rates among HIV-infected adults in West Africa with CD4 counts greater than 200/mm³ and no antiretroviral treatment. Data from five cohorts during 1996-2009 involving 2,588 patients over 6,862 person-years of follow-up reveal significant insights into mortality rates, loss to follow-up, and ART initiation. Findings indicate that lower rates of loss to follow-up and ART initiation correlate with higher mortality estimates, challenging perceptions of morbidity in resource-limited settings.

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CD4-Specific Mortality and Tuberculosis Rates in Untreated HIV-Infected Adults in West Africa

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  1. CD4-specific rates of death and tuberculosis among HIV-infected adults with high CD4 counts and no antiretroviral treatment in West Africa Lewden C1,2, Delphine Gabillard1,2, Minga A2,3, Messou E2, 4, Ekouevi D2, Konate I5, Tonwe-Gold B6, Ouedraogo A5, Leroy V1,2, Dabis F1,2, Laurent C7, Anglaret X1,2 and the ANRS 12222 Morbidity/Mortality Study Group 1Inserm/ Université Bordeaux Segalen, U897, ISPED, Bordeaux, France, 2Programme PAC-CI, Abidjan, Côte d'Ivoire, 3Centre Médical de Suivi des Donneurs de Sang (CMSDS), Abidjan, Côte d'Ivoire, 4Centre de Prise en charge de Recherche et de Formation (CePReF), Aconda, Abidjan,Côte d'Ivoire, 5Centre MURAZ / Ministère de la Santé, Bobo-Dioulasso, Burkina Faso, 6Aconda MTCT-Plus Program, Abidjan, Côte d'Ivoire, 7IRD/Université Montpellier I, UMI233, Montpellier, France WEPDB0204

  2. CD4-specific rates of mortality, TB, LTFU and ART initiation In untreated West African HIV-infected adults with >200 CD4/mm3 Pooled analysis of ANRS funded cohorts • 5 cohorts • in West Africa • years 1996-2009 • CD4 /six months • Standardized • follow-up • Joint model • (linear mixed • and survival) • 2588 patients • 6862 p-years 1

  3. Estimates of mortality, LTFU and ART initiation rates in cohorts with the highest and lowest mortality rates 2

  4. Estimates of mortality, LTFU and ART initiation rates in cohorts with the highest and lowest mortality rates 2

  5. Estimates of mortality, LTFU and ART initiation rates in cohorts with the highest and lowest mortality rates 2

  6. Estimates of mortality, LTFU and ART initiation rates in cohorts with the highest and lowest mortality rates 2

  7. Estimates of mortality, LTFU and ART initiation rates in cohorts with the highest and lowest mortality rates 2

  8. Conclusion • 1st message : • Data censoring due to LTFU and ART initiation may be informative, and mortality estimates may be more accurate when rates of LTFU and ART initiation are lower; • Rates of LTFU and ART initiation should be systematically provided when reporting CD4-specific rates of mortality. • 2nd message : • In cohorts with low LTFU and ART initiation rates, mortality rates in patients with >200 CD4/mm3 look substantially higher than those estimated in high resource countries. 3

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