AIDS 2024: Changes in Early HIVAIDS Mortality Rate in People Starting Antiretroviral Treatment Between 2013 and 2023: A Multicenter Survival Study in Senegal
Speaker: Bruce Shinga Wembulua
Human Immunodeficiency Virus (HIV)-related mortality has substantially decreased since the advent of antiretroviral therapy (ART), with over 20 million deaths averted since 1990. Despite this progress, HIV infection continues to pose significant challenges in sub-Saharan Africa. A study involving over 20,000 participants revealed that early mortality rates were higher in low-income countries compared to high-income countries, primarily due to late presentation of treatment, as well as the reduced potency and durability of earlier ART regimens. Senegal implemented the Universal Test and Treat Strategy in 2016 and adopted a Dolutegravir (DTG)-based regimen in 2019, which potentially improved early mortality outcomes. However, data from Africa regarding the impact of these strategies remain limited.
The study aimed to evaluate changes in early mortality rates among HIV patients across various ART initiation periods in Senegal. Conducted at six HIV clinics from 2013 to 2023, the study focused on early death, defined as death occurring within the first 12 months of ART initiation. It employed the calculation practice method and the shared frailty model to estimate cumulative incidences and examine the relationship between early death and ART initiation periods. The analysis adjusted for factors including age, gender, World Health Organization (WHO) clinical stages, opportunistic infections, and hepatitis B surface antigen status.
The study included 4,006 participants, with 463 deaths, yielding a crude mortality rate of 3.5% per 100 person-years. Among these deaths, 227 occurred within the first 6 months and 296 within 12 months, resulting in cumulative incidences of 5.4% and 7.4%, respectively. The study observed an increase in the proportion of participants aged 55 and older and a higher proportion of men. Additionally, there was an increase in the proportion of participants at WHO clinical stages 1 and 2, along with higher Cluster of Differentiation 4 (CD4) counts. Participants who initiated treatment in the third period had lower mortality rates than those who started treatment in the first. Multivariable analysis indicated that initiating treatment in periods two and three was associated with a 27% and 63% reduction in one-year mortality, respectively.
In conclusion, the study found that early mortality rates varied depending on the ART initiation period, yet late presentation with low median CD4+ T-cell counts remains a significant challenge. Prioritizing the timely initiation of ART and closely monitoring patients who present late is crucial for reducing early mortality and improving overall survival outcomes.
The 25th International AIDS conference (AIDS 2024). 22nd-26th July, Munich, Germany
