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XVI International AIDS Conference, Toronto, Canada, 14 August 2006

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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XVI International AIDS Conference, Toronto, Canada, 14 August 2006

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  1. 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

  2. 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

  3. BACKGROUND (2) • TB among adult patients receiving HAART: • most frequent OI • leading cause of death (18%) • incidence?

  4. 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

  5. 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

  6. 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

  7. BASELINE CHARACTERISTICS (1)

  8. BASELINE CHARACTERISTICS (2)

  9. UNDETECTABLE VIRAL LOAD

  10. CHANGE IN CD4 COUNTS

  11. CUMULATIVE PROBABILITY OF DYING

  12. SURVIVAL PREDICTORS

  13. 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

  14. CUMULATIVE TB INCIDENCE

  15. TB HAZARD RATE

  16. BASELINE PREDICTORS OF TB

  17. 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

  18. 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

  19. 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

  20. 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

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