Risk of Deaths, AIDS-Defining and Non-AIDS Defining Events among Ghanaians on Long-Term Combination Antiretroviral Therapy
Identifieur interne : 000030 ( Pmc/Curation ); précédent : 000029; suivant : 000031Risk of Deaths, AIDS-Defining and Non-AIDS Defining Events among Ghanaians on Long-Term Combination Antiretroviral Therapy
Auteurs : Fred Stephen Sarfo [Ghana] ; Maame Anima Sarfo [Ghana] ; Betty Norman [Ghana] ; Richard Phillips [Ghana] ; George Bedu-Addo [Ghana] ; David Chadwick [Royaume-Uni]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Abstract
Combination antiretroviral therapy (cART) has been widely available in Ghana since 2004. The aim of this cohort study was to assess the incidences of death, AIDS-defining events and non-AIDS defining events and associated risk factors amongst patients initiating cART in a large treatment centre. Clinical and laboratory data were extracted from clinic and hospital case notes for patients initiating cART between 2004 and 2010 and clinical events graded according to recognised definitions for AIDS, non-AIDS events (NADE) and death, with additional events not included in such definitions such as malaria also included. The cumulative incidence of events was calculated using Kaplan Meier analysis, and association of risk factors with events by Cox proportional hazards regression. Data were closed for analysis on 31st December, 2011 after a median follow-up of 30 months (range, 0–90 months). Amongst 4,039 patients starting cART at a median CD4 count of 133 cells/mm3, there were 324 (8%) confirmed deaths, with an event rate of 28.83 (95% CI 25.78–32.15) deaths per 1000-person follow-up years; the commonest established causes were pulmonary TB and gastroenteritis. There were 681 AIDS-defining events (60.60 [56.14–65.33] per 1000 person years) with pulmonary TB and chronic diarrhoea being the most frequent causes. Forty-one NADEs were recorded (3.64 [2.61–4.95] per 1000 person years), of which hepatic and cardiovascular events were most common. Other common events recorded outside these definitions included malaria (746 events) and respiratory tract infections (666 events). Overall 24% of patients were lost-to-follow-up. Alongside expected risk factors, stavudine use was associated with AIDS [adjusted HR of 1.08 (0.90–1.30)] and death (adjusted HR of 1.60 [1.21–2.11]). Whilst frequency of AIDS and deaths in this cohort were similar to those described in other sub-Saharan African cohorts, rates of NADEs were lower and far exceeded by events such as malaria and respiratory tract infections.
Url:
DOI: 10.1371/journal.pone.0111400
PubMed: 25340766
PubMed Central: 4207829
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xml:lang="fr">Ghana</country><wicri:regionArea>Kwame Nkrumah University of Science and Technology, Kumasi</wicri:regionArea></affiliation></author><author><name sortKey="Sarfo, Maame Anima" sort="Sarfo, Maame Anima" uniqKey="Sarfo M" first="Maame Anima" last="Sarfo">Maame Anima Sarfo</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Komfo Anokye Teaching Hospital, Kumasi, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Komfo Anokye Teaching Hospital, Kumasi</wicri:regionArea></affiliation></author><author><name sortKey="Norman, Betty" sort="Norman, Betty" uniqKey="Norman B" first="Betty" last="Norman">Betty Norman</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Komfo Anokye Teaching Hospital, Kumasi, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Komfo Anokye Teaching Hospital, Kumasi</wicri:regionArea></affiliation></author><author><name sortKey="Phillips, Richard" sort="Phillips, Richard" uniqKey="Phillips R" first="Richard" last="Phillips">Richard Phillips</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Komfo Anokye Teaching Hospital, Kumasi, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Komfo Anokye Teaching Hospital, Kumasi</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Kwame Nkrumah University of Science and Technology, Kumasi, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Kwame Nkrumah University of Science and Technology, Kumasi</wicri:regionArea></affiliation></author><author><name sortKey="Bedu Addo, George" sort="Bedu Addo, George" uniqKey="Bedu Addo G" first="George" last="Bedu-Addo">George Bedu-Addo</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Komfo Anokye Teaching Hospital, Kumasi, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Komfo Anokye Teaching Hospital, 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when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Combination antiretroviral therapy (cART) has been widely available in Ghana since 2004. The aim of this cohort study was to assess the incidences of death, AIDS-defining events and non-AIDS defining events and associated risk factors amongst patients initiating cART in a large treatment centre. Clinical and laboratory data were extracted from clinic and hospital case notes for patients initiating cART between 2004 and 2010 and clinical events graded according to recognised definitions for AIDS, non-AIDS events (NADE) and death, with additional events not included in such definitions such as malaria also included. The cumulative incidence of events was calculated using Kaplan Meier analysis, and association of risk factors with events by Cox proportional hazards regression. Data were closed for analysis on 31<sup>st</sup> December, 2011 after a median follow-up of 30 months (range, 0–90 months). Amongst 4,039 patients starting cART at a median CD4 count of 133 cells/mm<sup>3</sup>, there were 324 (8%) confirmed deaths, with an event rate of 28.83 (95% CI 25.78–32.15) deaths per 1000-person follow-up years; the commonest established causes were pulmonary TB and gastroenteritis. There were 681 AIDS-defining events (60.60 [56.14–65.33] per 1000 person years) with pulmonary TB and chronic diarrhoea being the most frequent causes. Forty-one NADEs were recorded (3.64 [2.61–4.95] per 1000 person years), of which hepatic and cardiovascular events were most common. Other common events recorded outside these definitions included malaria (746 events) and respiratory tract infections (666 events). Overall 24% of patients were lost-to-follow-up. Alongside expected risk factors, stavudine use was associated with AIDS [adjusted HR of 1.08 (0.90–1.30)] and death (adjusted HR of 1.60 [1.21–2.11]). Whilst frequency of AIDS and deaths in this cohort were similar to those described in other sub-Saharan African cohorts, rates of NADEs were lower and far exceeded by events such as malaria and respiratory tract infections.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Akileswaran, C" uniqKey="Akileswaran C">C Akileswaran</name></author><author><name sortKey="Lurie, Mn" uniqKey="Lurie M">MN Lurie</name></author><author><name sortKey="Flanigan, Tp" uniqKey="Flanigan T">TP Flanigan</name></author><author><name sortKey="Mayer, Kh" uniqKey="Mayer K">KH Mayer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Braistein, P" uniqKey="Braistein P">P Braistein</name></author><author><name sortKey="Brinkhof, Mw" uniqKey="Brinkhof M">MW Brinkhof</name></author><author><name sortKey="Dabis, F" uniqKey="Dabis F">F Dabis</name></author><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25340766</article-id><article-id pub-id-type="pmc">4207829</article-id><article-id pub-id-type="publisher-id">PONE-D-14-15796</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0111400</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine and Health Sciences</subject><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Viral Diseases</subject><subj-group><subject>AIDS</subject></subj-group></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Risk of Deaths, AIDS-Defining and Non-AIDS Defining Events among Ghanaians on Long-Term Combination Antiretroviral Therapy</article-title><alt-title alt-title-type="running-head">Long-Term cART Outcomes in Ghana</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Sarfo</surname><given-names>Fred Stephen</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sarfo</surname><given-names>Maame Anima</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Norman</surname><given-names>Betty</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Phillips</surname><given-names>Richard</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bedu-Addo</surname><given-names>George</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Chadwick</surname><given-names>David</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Komfo Anokye Teaching Hospital, Kumasi, Ghana</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Kwame Nkrumah University of Science and Technology, Kumasi, Ghana</addr-line></aff><aff id="aff3"><label>3</label><addr-line>The James Cook University Hospital, Middlesbrough, United Kingdom</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Pett</surname><given-names>Sarah L.</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Faculty of Medicine, Australia</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>stephensarfo78@gmail.com</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: FSS DC. Performed the experiments: FSS DC. Analyzed the data: FSS MAS. Contributed reagents/materials/analysis tools: FSS BN GBA RP. Wrote the paper: FSS DC.</p></fn></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>23</day><month>10</month><year>2014</year></pub-date><volume>9</volume><issue>10</issue><elocation-id>e111400</elocation-id><history><date date-type="received"><day>8</day><month>4</month><year>2014</year></date><date date-type="accepted"><day>1</day><month>10</month><year>2014</year></date></history><permissions><copyright-year>2014</copyright-year><copyright-holder>Sarfo et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><p>Combination antiretroviral therapy (cART) has been widely available in Ghana since 2004. The aim of this cohort study was to assess the incidences of death, AIDS-defining events and non-AIDS defining events and associated risk factors amongst patients initiating cART in a large treatment centre. Clinical and laboratory data were extracted from clinic and hospital case notes for patients initiating cART between 2004 and 2010 and clinical events graded according to recognised definitions for AIDS, non-AIDS events (NADE) and death, with additional events not included in such definitions such as malaria also included. The cumulative incidence of events was calculated using Kaplan Meier analysis, and association of risk factors with events by Cox proportional hazards regression. Data were closed for analysis on 31<sup>st</sup> December, 2011 after a median follow-up of 30 months (range, 0–90 months). Amongst 4,039 patients starting cART at a median CD4 count of 133 cells/mm<sup>3</sup>, there were 324 (8%) confirmed deaths, with an event rate of 28.83 (95% CI 25.78–32.15) deaths per 1000-person follow-up years; the commonest established causes were pulmonary TB and gastroenteritis. There were 681 AIDS-defining events (60.60 [56.14–65.33] per 1000 person years) with pulmonary TB and chronic diarrhoea being the most frequent causes. Forty-one NADEs were recorded (3.64 [2.61–4.95] per 1000 person years), of which hepatic and cardiovascular events were most common. Other common events recorded outside these definitions included malaria (746 events) and respiratory tract infections (666 events). Overall 24% of patients were lost-to-follow-up. Alongside expected risk factors, stavudine use was associated with AIDS [adjusted HR of 1.08 (0.90–1.30)] and death (adjusted HR of 1.60 [1.21–2.11]). Whilst frequency of AIDS and deaths in this cohort were similar to those described in other sub-Saharan African cohorts, rates of NADEs were lower and far exceeded by events such as malaria and respiratory tract infections.</p></abstract><funding-group><funding-statement>Funding for setting up the database was provided by the HIV Research Trust, UK. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="12"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are included within the paper. Additional related data are available from the Committee on Human Research Publications and Ethics (CHRPE), Kwame Nkrumah University of Science and Technology for researchers who meet the criteria for access to confidential data. Contact details of the ethics committee: The CHRPE Office, Room 7 Anatomy Block 3, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi or <email>chrpe.knust.kath@gmail.com</email>. Contact the corresponding author with any questions (<email>stephensarfo78@gmail.com</email>).</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are included within the paper. Additional related data are available from the Committee on Human Research Publications and Ethics (CHRPE), Kwame Nkrumah University of Science and Technology for researchers who meet the criteria for access to confidential data. Contact details of the ethics committee: The CHRPE Office, Room 7 Anatomy Block 3, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi or <email>chrpe.knust.kath@gmail.com</email>. Contact the corresponding author with any questions (<email>stephensarfo78@gmail.com</email>).</p></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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