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Tuberculosis incidence and risk factors among adult patients receiving HAART in Senegal: a 7-year cohort study Assane DIOUF et al . IRD/UMR 145 CRCF, CHNU de Fann. XVI International AIDS Conference, Toronto, Canada, 14 August 2006. BACKGROUND (1). TB in Senegal (WHO 2004):
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Tuberculosis incidence and risk factors among adult patients receiving HAART in Senegal: a 7-year cohort study Assane DIOUF et al. IRD/UMR 145 CRCF, CHNU de Fann XVI International AIDS Conference, Toronto, Canada, 14 August 2006
BACKGROUND (1) • TB in Senegal (WHO 2004): • incidence: 2.45 cases/1000 person-yrs • mortality: 52 cases/100000 p-y • TB and HIV infection: • first opportunistic infection (OI); • difficulties in diagnosis and treatment; • HIV prevalence = 15% among TB patients
BACKGROUND (2) • TB among adult patients receiving HAART: • most frequent OI • leading cause of death (18%) • incidence?
OBJECTIVES • Assessment of HAART efficacy 7 years and half after initiation • Determine incidence and risk factors of tuberculosis ANRS 1290 COHORT Inclusion period: August 1998 - April 2002 N = 403
FOLLOW-UP VISITS • Pre-enrolment and enrollment visits: clinical, biology, CD4 counts, viral load • M1 : clinical, viral load (VL), adherence • Bi-monthly visits: clinical, adherence, serious adverse events (SAE) • Six-monthly visits: clinical, adherence, SAE, standard biology, CD4 counts, VL
MONITORING AT MARCH 31, 2006 • Participation time • median: 52 months • range: 0.6 – 90 months • Deaths: 95 • Lost to follow-up • 1st year: 7 • 2d year: 8 • 3d year: 7 • 1543 p-y at risk as of March 31, 2006
TB INCIDENT CASES N = 47 • 30 incident cases declared as an adverse event during follow-up: • 23 alive as of March 31, 2006 • 7 dead from non-TB cause • 17 deaths due to TB which was not previously recorded Overall incidence rate:3.1/100 p-y
PREVIOUS FINDINGS (1) • Seyler C: Ivory coast, 7 yrs cohort study • 4.8/100 p-y • Risk factors: history of tuberculosis (11.3 vs 3/100 p-y) • Lawn SD: South africa, 5 yrs follow up • 3.5/100 p-y in the 1st yr; 1/100 in the 5th yr • Risk factors associated: CD4 cells < 100/µL;WHO stage 3 or 4; age < 33 yrs
PREVIOUS FINDINGS (2) • Girardi: Europa and North America, three yrs • 4.69/1000 p-y (D0-M36); • 3.1/1000 p-y (M6-M36) • Risk factors: • low CD4 count at D0 and at M6; • VL > 400/mL at M6
CONCLUSIONS • Good immunological and virological efficacy • Short term mortality after HAART initiation remains high • Early occurrence of TB (first year) • Role of IRIS? • Benefits of INH preventive therapy? • Necessity of early tracking of HIV • Necessity of collaboration between AIDS TB programs
CHNU Fann, Centre Régional de Recherche Clinique et de Formation sur le VIH/sida, Dakar, Sénégal • Diouf A • Dieng AB • CHNU Fann, Clinique des Maladies Infectieuses, Dakar, Sénégal : • Sow PS • Ndiaye I • CHNU Fann, Centre de Traitement Ambulatoire, Dakar, Sénégal: • Ngom Guèye NF • Hôpital Principal de Dakar: • Guèye PM • Ba Fall K ANRS 1290 STUDY GROUP • Institut de Recherche pour le Développement, UMR 145, Montpellier, France: • Etard JF • Delaporte E • Laurent C • Thierry-Mieg M • Conseil National de Lutte contre le Sida, Dakar, Sénégal : • Cilote V • Lanièce I • Ndoye I