Changes in early HIV/AIDS mortality rates in people initiating antiretroviral treatment between 2013 and 2023: A 10-year multicenter survival study in Senegal

Abstract

Background: HIV/AIDS-related early mortality has long been a significant challenge. Subsequent to recent policy changes and treatment advancements, we aimed to assess changes in early mortality rates in 2017-19 and 2020-23 compared to 2013-16.

Methods: This is a 10-year multicenter survival study in people living with human immunodeficiency virus having initiated ART between 2013 and 2023. We used frailty-based competing risk models to estimate adjusted early (6-month and one-year) mortality hazard ratios (HRs) in people living with HIV (PwHIV) having initiated ART in 2013-16 (comparator), 2017-19, and 2020-23.

Results: We enrolled 4006 persons of whom 2281 (56.9 %) were female; median age was 40 years (IQR: 31-50); 635 (15.9 %) were at WHO clinical stage IV and 934 (23.3 %) had a CD4 count <200 cells/mm³. Median follow-up was 80.4 months (IQR: 48.6-106.7). All in all, 463 participants died (4.37 deaths per 100 person-years), including 296 at one year of follow-up (7.4 % [95 % CI: 6.6-8.2]). ART initiation in 2016-19 and 2020-23 was associated with 27 % (adjusted HR [aHR]: 0.73; 95 % CI: 0.55-0.98) and 63 % (aHR: 0.37; 95 % CI: 0.25-0.56) reductions in one-year mortality rates, respectively, compared to the 2013-16 period.

Conclusion: Early mortality risk has significantly decreased over time in Senegal. However, the proportion of PwHIV with AIDS-defining conditions remains concerning. Continued efforts to ensure early diagnosis and prompt linkage to care are needed for more impact.

Keywords: Antiretroviral therapy; HIV mortality rate; Senegal; Survival study; Universal test and treat.