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Www.ias2011.org CD4-specific rates of death and tuberculosis among HIV-infected adults with high CD4 counts and no antiretroviral treatment in West Africa.

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Presentation on theme: "Www.ias2011.org CD4-specific rates of death and tuberculosis among HIV-infected adults with high CD4 counts and no antiretroviral treatment in West Africa."— Presentation transcript:

1 www.ias2011.org CD4-specific rates of death and tuberculosis among HIV-infected adults with high CD4 counts and no antiretroviral treatment in West Africa Lewden C 1,2, Delphine Gabillard 1,2, Minga A 2,3, Messou E 2, 4, Ekouevi D 2, Konate I 5, Tonwe- Gold B 6, Ouedraogo A 5, Leroy V 1,2, Dabis F 1,2, Laurent C 7, Anglaret X 1,2 and the ANRS 12222 Morbidity/Mortality Study Group 1 Inserm/ Université Bordeaux Segalen, U897, ISPED, Bordeaux, France, 2 Programme PAC-CI, Abidjan, Côte d'Ivoire, 3 Centre Médical de Suivi des Donneurs de Sang (CMSDS), Abidjan, Côte d'Ivoire, 4 Centre de Prise en charge de Recherche et de Formation (CePReF), Aconda, Abidjan,Côte d'Ivoire, 5 Centre MURAZ / Ministère de la Santé, Bobo-Dioulasso, Burkina Faso, 6 Aconda MTCT-Plus Program, Abidjan, Côte d'Ivoire, 7 IRD/Université Montpellier I, UMI233, Montpellier, France WEPDB0204

2 www.ias2011.org 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 www.ias2011.org Estimates of mortality, LTFU and ART initiation rates in cohorts with the highest and lowest mortality rates Mortality /100PY Highest and lowest LFTU /100PY ART initiation /100PY CD4 strataRate 95% CI Rate 95% CI Rate 95% CI 201 to 350 Low 0.9 (0.2-2.7) 14.7 (10.5-18.9) 60.6 (52.1-69.2) High 5.0 (3.2-6.7) 4.7 (3.1-6.7) 3.4 (2.1-5.2) 351 to 500 Low 0.5 (0.0-2.7) 3.4 (1.4-7.0) 1.0 (0.1-3.5) High 2.9 (1.5-5.2) 1.6 (0.6-3.5) 0.8 (0.2-2.3) 501 to 650 Low 0.0 (0.0-1.5) 7.1 (4.1-11.3) 0.0 (0.0-1.5) High 0.8 (0.1-3.0) 2.0 (0.7-4.8) 0.0 (0.0-1.5) >650 Low 0.0 (0.0-1.2) 9.7 (6.5-13.9) 0.0 (0.0-1.2) High 0.3 (0.0-1.9) 0.7 (0.1-2.4) 1.4 (0.4-3.5) 2

4 www.ias2011.org Estimates of mortality, LTFU and ART initiation rates in cohorts with the highest and lowest mortality rates Mortality /100PY Highest and lowest LFTU /100PY ART initiation /100PY CD4 strataRate 95% CI Rate 95% CI Rate 95% CI 201 to 350 Low 0.9 (0.2-2.7) 14.7 (10.5-18.9) 60.6 (52.1-69.2) High 5.0 (3.2-6.7) 4.7 (3.1-6.7) 3.4 (2.1-5.2) 351 to 500 Low 0.5 (0.0-2.7) 3.4 (1.4-7.0) 1.0 (0.1-3.5) High 2.9 (1.5-5.2) 1.6 (0.6-3.5) 0.8 (0.2-2.3) 501 to 650 Low 0.0 (0.0-1.5) 7.1 (4.1-11.3) 0.0 (0.0-1.5) High 0.8 (0.1-3.0) 2.0 (0.7-4.8) 0.0 (0.0-1.5) >650 Low 0.0 (0.0-1.2) 9.7 (6.5-13.9) 0.0 (0.0-1.2) High 0.3 (0.0-1.9) 0.7 (0.1-2.4) 1.4 (0.4-3.5) 2

5 www.ias2011.org Estimates of mortality, LTFU and ART initiation rates in cohorts with the highest and lowest mortality rates Mortality /100PY Highest and lowest LFTU /100PY ART initiation /100PY CD4 strataRate 95% CI Rate 95% CI Rate 95% CI 201 to 350 Low 0.9 (0.2-2.7) 14.7 (10.5-18.9) 60.6 (52.1-69.2) High 5.0 (3.2-6.7) 4.7 (3.1-6.7) 3.4 (2.1-5.2) 351 to 500 Low 0.5 (0.0-2.7) 3.4 (1.4-7.0) 1.0 (0.1-3.5) High 2.9 (1.5-5.2) 1.6 (0.6-3.5) 0.8 (0.2-2.3) 501 to 650 Low 0.0 (0.0-1.5) 7.1 (4.1-11.3) 0.0 (0.0-1.5) High 0.8 (0.1-3.0) 2.0 (0.7-4.8) 0.0 (0.0-1.5) >650 Low 0.0 (0.0-1.2) 9.7 (6.5-13.9) 0.0 (0.0-1.2) High 0.3 (0.0-1.9) 0.7 (0.1-2.4) 1.4 (0.4-3.5) 2

6 www.ias2011.org Estimates of mortality, LTFU and ART initiation rates in cohorts with the highest and lowest mortality rates Mortality /100PY Highest and lowest LFTU /100PY ART initiation /100PY CD4 strataRate 95% CI Rate 95% CI Rate 95% CI 201 to 350 Low 0.9 (0.2-2.7) 14.7 (10.5-18.9) 60.6 (52.1-69.2) High 5.0 (3.2-6.7) 4.7 (3.1-6.7) 3.4 (2.1-5.2) 351 to 500 Low 0.5 (0.0-2.7) 3.4 (1.4-7.0) 1.0 (0.1-3.5) High 2.9 (1.5-5.2) 1.6 (0.6-3.5) 0.8 (0.2-2.3) 501 to 650 Low 0.0 (0.0-1.5) 7.1 (4.1-11.3) 0.0 (0.0-1.5) High 0.8 (0.1-3.0) 2.0 (0.7-4.8) 0.0 (0.0-1.5) >650 Low 0.0 (0.0-1.2) 9.7 (6.5-13.9) 0.0 (0.0-1.2) High 0.3 (0.0-1.9) 0.7 (0.1-2.4) 1.4 (0.4-3.5) 2

7 www.ias2011.org Estimates of mortality, LTFU and ART initiation rates in cohorts with the highest and lowest mortality rates Mortality /100PY Highest and lowest LFTU /100PY ART initiation /100PY CD4 strataRate 95% CI Rate 95% CI Rate 95% CI 201 to 350 Low 0.9 (0.2-2.7) 14.7 (10.5-18.9) 60.6 (52.1-69.2) High 5.0 (3.2-6.7) 4.7 (3.1-6.7) 3.4 (2.1-5.2) 351 to 500 Low 0.5 (0.0-2.7) 3.4 (1.4-7.0) 1.0 (0.1-3.5) High 2.9 (1.5-5.2) 1.6 (0.6-3.5) 0.8 (0.2-2.3) 501 to 650 Low 0.0 (0.0-1.5) 7.1 (4.1-11.3) 0.0 (0.0-1.5) High 0.8 (0.1-3.0) 2.0 (0.7-4.8) 0.0 (0.0-1.5) >650 Low 0.0 (0.0-1.2) 9.7 (6.5-13.9) 0.0 (0.0-1.2) High 0.3 (0.0-1.9) 0.7 (0.1-2.4) 1.4 (0.4-3.5) 2

8 www.ias2011.org 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/mm 3 look substantially higher than those estimated in high resource countries. 3

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