Changes in early HIV/AIDS mortality rates in people initiating antiretroviral treatment between 2013 and 2023: A 10-year multicenter survival study in Senegal - 06/12/24
, Viviane Marie Pierre Cisse a, Daye Ka a, Ndeye Fatou Ngom b, Ahmadou Mboup b, Ibrahima Diao b, Aminata Massaly c, Catherine Sarr a, Kalilou Diallo d, Mouhamadou Baïla Diallo a, Moustapha Diop e, Papa Samba Ba e, Noël Magloire Manga d, Stanislas Okitotsho Wembonyama f, Zacharie Kibendelwa Tsongo f, Moussa Seydi aGraphical abstract |
Highlights |
• | The Proportion of participants with WHO stage I or II increased after the implementation of universal test and treat approach. |
• | The median CD4 count at the time of ART initiation increased between 2016 and 2023. |
• | ART initiation in 2017-2019 and 2020-2023 was associated with ∼60% reduction in one-year HIV mortality compared to 2013-2016. |
Abstract |
Background |
HIV/AIDS-related early mortality has long been a significant challenge. Subsequent to recent policy changes and treatment advancements, we aimed to assess changes in early mortality rates in 2017–19 and 2020-23 compared to 2013–16.
Methods |
This is a 10-year multicenter survival study in people living with human immunodeficiency virus having initiated ART between 2013 and 2023. We used frailty-based competing risk models to estimate adjusted early (6-month and one-year) mortality hazard ratios (HRs) in people living with HIV (PwHIV) having initiated ART in 2013–16 (comparator), 2017–19, and 2020–23.
Results |
We enrolled 4006 persons of whom 2281 (56.9 %) were female; median age was 40 years (IQR: 31–50); 635 (15.9 %) were at WHO clinical stage IV and 934 (23.3 %) had a CD4 count <200 cells/mm3. Median follow-up was 80.4 months (IQR: 48.6–106.7). All in all, 463 participants died (4.37 deaths per 100 person-years), including 296 at one year of follow-up (7.4 % [95 % CI: 6.6–8.2]). ART initiation in 2016–19 and 2020–23 was associated with 27 % (adjusted HR [aHR]: 0.73; 95 % CI: 0.55–0.98) and 63 % (aHR: 0.37; 95 % CI: 0.25–0.56) reductions in one-year mortality rates, respectively, compared to the 2013–16 period.
Conclusion |
Early mortality risk has significantly decreased over time in Senegal. However, the proportion of PwHIV with AIDS-defining conditions remains concerning. Continued efforts to ensure early diagnosis and prompt linkage to care are needed for more impact.
Le texte complet de cet article est disponible en PDF.Keywords : Antiretroviral therapy, Universal test and treat, HIV mortality rate, Survival study, Senegal
Abbreviations : HIV, DTG, NNRTI, NRTI, RAL, PI, WHO, cell, HBsAg, CI
Plan
Vol 54 - N° 8
Article 104990- décembre 2024 Retour au numéro
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