Limits...
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

First period: from HAART initiation to 24 months. CD4-cell count trajectories before TB notification (solid lines: positive gain; dashed lines: negative gain) and CD4-cell count progression among TB-free patients as background (solid lines from bottom to top: 5th, 25th, median, 75th and 95th percentile of the distribution).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2812839&req=5

Figure 2: First period: from HAART initiation to 24 months. CD4-cell count trajectories before TB notification (solid lines: positive gain; dashed lines: negative gain) and CD4-cell count progression among TB-free patients as background (solid lines from bottom to top: 5th, 25th, median, 75th and 95th percentile of the distribution).

Mentions: Among the 25 cases identified within the first period, only 11 CD4 trajectories with at least 2 measures before TB notification were available. The background of Fig. (2) displays the 5th, 25th, 50th, 75th and 95th percentile of the CD4-cell progression among patients remaining free of TB over the period and is used as “reference” progression (median 24-month gain : 197 CD4-cells/µL). The 11 CD4 trajectories of TB cases, superimposed on that background, shows that only three trajectories are sharply decreasing, crossing several quintile distribution bands between baseline and 6-month measurement. The other eight courses, all with duration before TB notification beyond six months of HAART, are increasing or comprised within the “reference” progression bands with a median gain of 124 CD4-cells/µL [IQR: 65 – 192] before TB notification.


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)

First period: from HAART initiation to 24 months. CD4-cell count trajectories before TB notification (solid lines: positive gain; dashed lines: negative gain) and CD4-cell count progression among TB-free patients as background (solid lines from bottom to top: 5th, 25th, median, 75th and 95th percentile of the distribution).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: First period: from HAART initiation to 24 months. CD4-cell count trajectories before TB notification (solid lines: positive gain; dashed lines: negative gain) and CD4-cell count progression among TB-free patients as background (solid lines from bottom to top: 5th, 25th, median, 75th and 95th percentile of the distribution).
Mentions: Among the 25 cases identified within the first period, only 11 CD4 trajectories with at least 2 measures before TB notification were available. The background of Fig. (2) displays the 5th, 25th, 50th, 75th and 95th percentile of the CD4-cell progression among patients remaining free of TB over the period and is used as “reference” progression (median 24-month gain : 197 CD4-cells/µL). The 11 CD4 trajectories of TB cases, superimposed on that background, shows that only three trajectories are sharply decreasing, crossing several quintile distribution bands between baseline and 6-month measurement. The other eight courses, all with duration before TB notification beyond six months of HAART, are increasing or comprised within the “reference” progression bands with a median gain of 124 CD4-cells/µL [IQR: 65 – 192] before TB notification.

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