Effect of gender and age on mortality and retention among HIV-2-infected individuals starting antiretroviral therapy in West Africa: a multicentre cohort study
Background: HIV-2 infected individuals usually initiate ART at an advanced age
compared to HIV-1 patients and this could impact retention in care and
treatment outcomes. This study aimed at investigating the effect of gender and age
on mortality and lost-to-follow-up (LTFU) among HIV-2 patients in care in
Africa.
Methods: AnaAnalyses
were conducted using the database of the IeDEA-HIV-2 West Africa collaboration including
15 West African clinics. All patients who initiated ART were eligible and LTFU
was considered if >180 days since last visit. Probability of death and LTFU were
estimated with Kaplan-Meier method according to gender and age (16-39; 40-49; ≥50
years). A Cox regression model was used to identify factors associated with death
and/or LTFU.
Results: A
total of 1,392 HIV-2 patients were included with a median age of 45 years
(inter-quartile range [37-51]) and median CD4 count at ART initiation of 175/µL
[78-248]; 832 (60%) were women, 482
(35%) were aged 16-39, 522 (38%) aged 40-49 and 388 (28%) ≥50 years. At
baseline, 176 (13%) patients were at WHO clinical stage III/IV, 290 (20%) had a
BMI < 18, 251 (18%) had haemoglobin >10 g/dL and 312 (22%) had CD4 < 100
cell/µL. The median follow up was 22.5 months [7.1 - 48.2] during which 150 patients
died (10.8%) and 821 (59%) were LTFU. Males were more likely to die than
females (14% vs 9%; p=0.003). LTFU was
more frequent in patients aged ≥50 (39%) than in those aged 16-39 (31%) and
40-49 years (31%) (p=0.001). In multivariate analysis, male gender (hazard
ratio HR=2.2; 95%CI [1.5; 3.2]; p< 0.01), CD4 count < 100 cell/µL (HR=7.3 [1.7;
32.3]; p< 0.01), severe anaemia < 7g/dL (HR=7.0 [2.6; 19.1]; p< 0.01) and
BMI < 18 Kg/m² (HR=2.7 [1.4; 5.6]; p=0.03) were associated with higher mortality.
Adjusted on other factors, age was no longer associated
with LTFU.
Conclusions: The
risks of death and LTFU among HIV-2 patients on ART seem comparable to those in
HIV-1 patients in West Africa, despite ART initiation at an advanced age. However, the mortality and LTFU rates remain
elevated in this population where preventive and corrective
interventions should be explored.
B.K. Tchounga1,2, P.J. Coffie Ahuatchi1,3, E. Balestre2, E. Messou3,4, A. Sawadogo5, M. Seydi6, A. Minga7, D. Hawerlander8, S.P. Eholie1,3, F. Dabis2, D.K. Ekouevi1,2,9
1Programme PACCI, Site de Recherche ANRS, Abidjan, Cote D'Ivoire, 2Université de Bordeaux, ISPED, Centre INSERM U 897- Epidémiologie-Biostatistique, Bordeaux, France, 3Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Cote D'Ivoire, 4Centre de Prise en Charge de Recherche et de Formation. CePReF-Aconda, Abidjan, Cote D'Ivoire, 5Service des Maladies Infectieuses et Tropicales, CHU Souro Sanou, Hôpital de Jour, Bobo Dioulasso, Burkina Faso, 6Service des Maladies Infectieuses et Tropicale CHU FANN, Dakar, Senegal, 7Centre Médical de Suivi de Donneurs de Sang/CNTS, Abidjan, Cote D'Ivoire, 8Centre Intégré de Recherches Biocliniques d'Abidjan CIRBA, Abidjan, Cote D'Ivoire, 9Université de Lomé, Département des Sciences Fondamentales et Santé Publique, Lome, Togo