Associated factors with mortality in people living with HIV in Ziguinchor, Southern-region, Senegal: about 804 cases

Abstract Background: The effectiveness and increasingly easy access to highly active antiretroviral treatment (ART) have contributed to a considerable drop in HIV-related mortality. However, the mortality of adults in people living with HIV (PLHIV) remains overall higher than in the population in general. The objective of this study was to determine the associated factors with the occurrence of death in (PLHIV) followed in Ziguinchor , in order to improve the care of these patients in our context.Patients and method: This was a cross-sectional, descriptive and analytical study on cohorts of PLHIV followed in the health districts of Ziguinchor during 5 years. All PLHIV, aged 15 and beyond, regularly followed on antiretroviral treatment during the study period in those health districts were included.Results: We included 804 patients, women represented 597 (74.25%), i.e. a sex ratio (F/M) of 2.88. The average age was 45.61 ± 13.01 years with extremes from 15 to 96 years. The 46-60 age group was the most represented, 297 (36.94%). 286 patients (35.58%) were diagnosed at stages 3 and 4 of WHO. 82.34% were infected with HIV1. HIV2 was found in 122 (15.17%) patients and the dual profile in 20 cases (2.49%). The average CD4 count was 327±295/mm3 with extremes from 1 to 2156/mm3. Two hundred and thirteen patients (40.73%) had a CD4 count below 200/mm3 and 117 patients (22.37%) had a CD4 count above 500/mm3. Antiretroviral treatment was initiated in 791 patients (98.38%). The antiretroviral regimen combined 2 NRTIs (nucleoside reverse transcriptase inhibitor) with 1 NNTI (non-nucleoside reverse transcriptase inhibitor) in 82.71% of cases. The average length of follow-up was 3.22±1.33 years (range 1 to 6 years). In multivariate analysis, the occurrence of death was associated with age greater than 65 years (p = 0.027), treatment duration < 12 months (p 0.005), delay in ARV treatment (CD4 at baseline less than 500 cells/mm3 (p=0.001) and high viral load greater than 1000 copies/mL (p=0.000) at baseline).Conclusion: Strengthening screening, early initiation of ART, strengthening the therapeutic arsenal of antiretrovirals, are the main factors to be taken into consideration in order to reduce mortality in HIV-infected patients.