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Short and Long-Term Incidence of Tuberculosis and CD4-Cell Count Dynamic on HAART in Senegal.

Etard JF, Diouf A, De Beaudrap P, Akoi K, Ngom-Guèye NF, Ndiaye I, Ecochard R, Sow PS, Eric D - Open AIDS J (2009)

Bottom Line: CD4-cell trajectories until TB notification were compared to non-TB developers within two distinct periods: from HAART initiation to 24 months and after.Annual incidence decreased with duration of HAART (trend in incidence: RR=0.26, p<10(-4)).This study provides an estimate of TB incidence among patients on HAART in Senegal and supports two underlying mechanisms.

View Article: PubMed Central - PubMed

Affiliation: Institut de Recherche pour le Développement - Université Montpellier 1/UMR 145, Montpellier, France.

ABSTRACT

Objectives: Estimate tuberculosis (TB) incidence among patients receiving HAART. Compare the dynamic of the CD4-cell count and viral load before notification of the TB with the dynamic among patients remaining free of TB.

Design: Prospective cohort with ascertainment of TB cases from medical records.

Methods: The first 404 adults HIV-1 infected patients enrolled in the Senegalese antiretroviral drug access initiative were eligible. CD4-cell and viral load were assessed at baseline and every 6 months. Patients receiving an antituberculosis treatment at HAART initiation were excluded from analysis. Any TB case notified after the first month of HAART was considered as an incident case. Follow-up was censored at death or at the last visit before March 31, 2008. CD4-cell trajectories until TB notification were compared to non-TB developers within two distinct periods: from HAART initiation to 24 months and after.

Results: Over 404 eligible patients, 352 were included in this analysis. Median follow-up reached 73 months and 1821 person-years were accrued. Half of the 42 incident cases were notified before month 19 of HAART yielding to an overall incident rate of 2.3/100 PY [1.7-3.1]. Annual incidence decreased with duration of HAART (trend in incidence: RR=0.26, p<10(-4)). During the first period, CD4-cell count dynamic of most TB patients was identical to the dynamic among patients remaining free of TB. Most cases of the second period occurred in a context of an immunological failure.

Conclusions: This study provides an estimate of TB incidence among patients on HAART in Senegal and supports two underlying mechanisms.

No MeSH data available.


Related in: MedlinePlus

Flowchart of patients selection, ANRS 1215 cohort, Senegal, 1998-2008.
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Figure 1: Flowchart of patients selection, ANRS 1215 cohort, Senegal, 1998-2008.

Mentions: After exclusion of 47 “prevalent” cases and five cases which occurred during the first month, 352 patients were included in the TB incidence study and followed for a median duration of 73 months [IQR: 28-84] (Fig. 1). As of March 31, 2008, the largest participation time on HAART reached 9.5 years and 1821 person-years of observation were accrued. Between two and seven patients were lost to follow-up per year until the sixth year of the study and 91 all-cause deaths were recorded with a median survival time of 24 months [IQR: 6-32].


Short and Long-Term Incidence of Tuberculosis and CD4-Cell Count Dynamic on HAART in Senegal.

Etard JF, Diouf A, De Beaudrap P, Akoi K, Ngom-Guèye NF, Ndiaye I, Ecochard R, Sow PS, Eric D - Open AIDS J (2009)

Flowchart of patients selection, ANRS 1215 cohort, Senegal, 1998-2008.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2812839&req=5

Figure 1: Flowchart of patients selection, ANRS 1215 cohort, Senegal, 1998-2008.
Mentions: After exclusion of 47 “prevalent” cases and five cases which occurred during the first month, 352 patients were included in the TB incidence study and followed for a median duration of 73 months [IQR: 28-84] (Fig. 1). As of March 31, 2008, the largest participation time on HAART reached 9.5 years and 1821 person-years of observation were accrued. Between two and seven patients were lost to follow-up per year until the sixth year of the study and 91 all-cause deaths were recorded with a median survival time of 24 months [IQR: 6-32].

Bottom Line: CD4-cell trajectories until TB notification were compared to non-TB developers within two distinct periods: from HAART initiation to 24 months and after.Annual incidence decreased with duration of HAART (trend in incidence: RR=0.26, p<10(-4)).This study provides an estimate of TB incidence among patients on HAART in Senegal and supports two underlying mechanisms.

View Article: PubMed Central - PubMed

Affiliation: Institut de Recherche pour le Développement - Université Montpellier 1/UMR 145, Montpellier, France.

ABSTRACT

Objectives: Estimate tuberculosis (TB) incidence among patients receiving HAART. Compare the dynamic of the CD4-cell count and viral load before notification of the TB with the dynamic among patients remaining free of TB.

Design: Prospective cohort with ascertainment of TB cases from medical records.

Methods: The first 404 adults HIV-1 infected patients enrolled in the Senegalese antiretroviral drug access initiative were eligible. CD4-cell and viral load were assessed at baseline and every 6 months. Patients receiving an antituberculosis treatment at HAART initiation were excluded from analysis. Any TB case notified after the first month of HAART was considered as an incident case. Follow-up was censored at death or at the last visit before March 31, 2008. CD4-cell trajectories until TB notification were compared to non-TB developers within two distinct periods: from HAART initiation to 24 months and after.

Results: Over 404 eligible patients, 352 were included in this analysis. Median follow-up reached 73 months and 1821 person-years were accrued. Half of the 42 incident cases were notified before month 19 of HAART yielding to an overall incident rate of 2.3/100 PY [1.7-3.1]. Annual incidence decreased with duration of HAART (trend in incidence: RR=0.26, p<10(-4)). During the first period, CD4-cell count dynamic of most TB patients was identical to the dynamic among patients remaining free of TB. Most cases of the second period occurred in a context of an immunological failure.

Conclusions: This study provides an estimate of TB incidence among patients on HAART in Senegal and supports two underlying mechanisms.

No MeSH data available.


Related in: MedlinePlus