Wembulua Bruce Shinga, Cisse Viviane Marie Pierre, Ka Daye, Ngom Ndeye Fatou, Mboup Ahmadou, Diao Ibrahima, Massaly Aminata, Sarr Catherine, Diallo Kalilou, Diallo Mouhamadou Baïla, Diop Moustapha, Ba Papa Samba, Manga Noël Magloire, Wembonyama Stanislas Okitotsho, Tsongo Zacharie Kibendelwa, Seydi Moussa
Service des Maladies Infectieuses et Tropicales (SMIT), Fann University Hospital, Dakar, Senegal; School of Public Health, Goma University, Goma, Democratic Republic of the Congo.
Service des Maladies Infectieuses et Tropicales (SMIT), Fann University Hospital, Dakar, Senegal.
Infect Dis Now. 2024 Dec;54(8):104990. doi: 10.1016/j.idnow.2024.104990. Epub 2024 Oct 5.
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.
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.
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/mm. 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.
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.
与艾滋病毒/艾滋病相关的早期死亡率长期以来一直是一项重大挑战。在最近的政策变化和治疗进展之后，我们旨在评估2017 - 19年和2020 - 23年与2013 - 16年相比早期死亡率的变化。
这是一项为期10年的多中心生存研究，研究对象为2013年至2023年开始接受抗逆转录病毒治疗（ART）的艾滋病毒感染者。我们使用基于脆弱性的竞争风险模型来估计2013 - 16年（对照）、2017 - 19年和2020 - 23年开始接受ART的艾滋病毒感染者（PwHIV）调整后的早期（6个月和1年）死亡风险比（HRs）。
我们纳入了4006人，其中2281人（56.9%）为女性；中位年龄为40岁（四分位间距：31 - 50岁）；635人（15.9%）处于世界卫生组织临床IV期，934人（23.3%）的CD4细胞计数<200个细胞/mm³。中位随访时间为80.4个月（四分位间距：48.6 - 106.7个月）。总体而言，463名参与者死亡（每100人年4.37例死亡），其中296人在随访1年时死亡（7.4%[95%置信区间：6.6 - 8.2]）。与2013 - 16年期间相比，2016 - 19年和2020 - 23年开始接受ART分别使1年死亡率降低了27%（调整后HR[aHR]：0.73；95%置信区间：0.55 - 0.98）和63%（aHR：0.37；95%置信区间：0.25 - 0.56）。
塞内加尔的早期死亡风险随时间显著降低。然而，患有艾滋病定义疾病的艾滋病毒感染者比例仍然令人担忧。需要继续努力确保早期诊断并及时与治疗相衔接，以产生更大影响。
