Overall 2,323 patients (1,234 women and 1,089 men) contributing 40,443 records were followed for a total 9,608 person-years. The median follow-up duration was 2.9 years. The main nationalities were: French 499 (23.7%), Haitian 903 (42.8%), Guyanese 218 (10.3%), Surinamese 246 (11.7%), and Brazilian 167 (7.9%). The median age at censoring was 39 years (25%-75% quartiles=31.07-48.07 years). At censoring the median CD4 count was 311 per mm3 (25%-75% quartiles=121-497 CD4/mm3) and the median CD8 count was 849 per mm3 (25%-75% quartiles=543-1238/mm3). At the time of the last observation 1251 persons were on antiretroviral treatment (53.8%).
There were a total of 370 deaths (3.85 deaths/100 person-years). The median time to death was 2.3 years (25%-75% quartiles=0.8-4.5 years). The incidence rate of death varied between time periods: 14.6 deaths/100 person-years before 1997, 4.4 deaths/100 person-years for 1997-2002, and 1.5 deaths/100 person-years for 2003-2008. The model results are shown in table 1. Being on tuberculosis treatment was associated with a greater hazard of death, adjusted Hazard Ratio (aHR)= 2.44 (95%CI=1.65-3.60)). The diagnoses of confirmed tuberculosis (aHR=5.37 (95%CI=2.29-12.58)), of histoplasmosis (aHR=1.97 (95%CI=1.19-3.26)), of toxoplasmosis (aHR=3.52 (95%CI=1.97-6.28)), and pneumocystosis (aHR=4.18 (95%CI=1.48-11.80)) were significantly and independently associated with death. Esophageal candidiasis, one of the most frequent opportunistic infections, was not independently associated with death and removed from the model. When looking at interactions between cotrimoxazole treatment and pneumocystosis, or between confirmed tuberculosis and tuberculosis treatment, there was a significant protective effect. It is of note that all patients who received anti-tuberculosis treatment (n=347) did not have a final diagnosis of tuberculosis (n=93). For histoplasmosis, 199 patients received antifungal treatment while 141 were diagnosed as having histoplasmosis. The Cox model showed that the main opportunistic infections (except esophageal candidiasis, removed from final model) were independently associated with increased mortality (Table 1).
Table 1 Factors associated with death in a cohort of HIV-infected patients in French Guiana 1992–2008: multivariate Cox modeling.
time at risk
(person-years)
|
Incidence
Rate
|
Adjusted
Hazard Ratio
|
95% Confidence Interval
|
P
|
Age < 30 years
|
1797
|
2.28
|
1
|
|
|
Age [30–40 years[
|
2998
|
4.16
|
1.69
|
1.10–2.59
|
0.01
|
Age [40–60 years[
|
4116
|
3.76
|
1. 47
|
1.14–2.64
|
0.009
|
Age > 60
|
696
|
7
|
6.16
|
3.70-10.27
|
0.000
|
1991–1996 time-period
|
773
|
14.6
|
5.29
|
3.56–7.87
|
0.000
|
1997–2002 time-period
|
4182
|
4.47
|
2.68
|
1.96–3.68
|
0.000
|
2003–2008 time-period
|
4652
|
1.5
|
1
|
|
|
CD8 < first quartile (643/ mm3)
|
2156
|
7.2
|
1.77
|
1.37–2.28
|
0.000
|
CD8 > = 643 per mm3
|
6716
|
2.09
|
|
|
|
CD4 <50
|
645
|
23.25
|
36.02
|
15.41–84.20
|
0.000
|
CD4 [50–200[
|
1809
|
5.14
|
12.34
|
5.32–28.63
|
0.000
|
CD4 [200–500[
|
4387
|
1.18
|
4.33
|
1.86–10.11
|
0.001
|
CD4 >500
|
2167
|
0.27
|
1
|
|
|
Antiretroviral treatment
|
4938
|
1.47
|
.30
|
0.22–0.40
|
0.000
|
No antiretroviral treatment
|
4670
|
6.35
|
|
|
|
Tuberculosis (any location)
|
62
|
36.69
|
5.37
|
2.29–12.58
|
0.000
|
No tuberculosis
|
9546
|
3.63
|
|
|
|
Tuberculosis treatment
|
238
|
24.3
|
2.44
|
1.65–3.60
|
0.000
|
No tuberculosis treatment
|
9370
|
3.32
|
|
|
|
Interaction confirmed tuberculosis and tuberculosis treatment
|
|
|
0.20
|
0.07–0.60
|
0.004
|
Histoplasmosis
|
105
|
35.89
|
1.97
|
1.19–3.26
|
0.008
|
No histoplasmosis
|
9502
|
3.49
|
|
|
|
Histoplasmosis treatment
|
289
|
7.2
|
.79
|
0.37–1.57
|
0.50
|
No histoplasmosis treatment
|
9319
|
3.74
|
|
|
|
Interaction confirmed histoplasmosis and antifungal treatment
|
|
|
1.09
|
0.37–3.15
|
0.86
|
Pneumocystosis
|
70
|
17.06
|
4.18
|
1.48–11.80
|
0.007
|
No pneumocystosis
|
9538
|
3.75
|
|
|
|
Cotrimoxazole
|
2230
|
6.77
|
1.44
|
1.08–193
|
0.01
|
No cotrimoxazole
|
7378
|
2.96
|
|
|
|
Interaction pneumocystosis cotrimoxazole
|
|
|
0.13
|
0.03–0.49
|
0.003
|
Toxoplasmosis
|
86
|
44.14
|
3.52
|
1.97–6.28
|
0.000
|
No toxoplasmosis
|
9522
|
3.48
|
|