Risk of Deaths, AIDS-Defining and Non-AIDS Defining Events among Ghanaians on Long-Term Combination Antiretroviral Therapy
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Date
2014-10-23
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PLOS ONE
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 followup
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.
Description
An article published by PLOS ONE and available at doi:10.1371/journal.pone.0111400
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Citation
PLoS ONE 9(10): e111400. doi:10.1371/journal.pone.0111400