SHORT COMMUNICATION Risk factors for death among patients in French Guiana: 1996–2005 M Nacher, 1,2 F Huber, 3 M El Guedj, 2 T Vaz, 2 C Magnien, 2 F Djossou, 4 A Randrianjohany, 5 F Alvarez 6 and P Couppie ´ 3 1 Centre d’Information et de Soins de l’Immunode´ficience Humaine (CISIH) de Guyane, 2 Hoˆpital de Jour Adultes, 3 Service de Dermatologie, and 4 Unite´des Maladies Infectieuses et Tropicales, Centre Hospitalier Andre´e Rosemon, Cayenne, French Guiana, 5 Service de Me´decine, Centre Hospitalier Frank Joly, Saint Laurent du Maroni, French Guiana, and 6 Service de Me´decine, Centre Me´dico Chirurgical de Kourou, Kourou, French Guiana Summary Risk factors for death in an HIV-infected cohort in French Guiana were studied in 1374 patients between 1996 and 2005. Of these patients, 48.5% were male and 76% were immigrants. Covariates were measured at the time of consultation. There were 223 deaths. Addictions [adjusted hazard ratio (HR) 5 13; 95% confidence interval (CI) 5.5–30.6; Po 0.001], age 460 years (HR 5 1.5; 95% CI 0.9–2.5; P 5 0.13), male gender (HR 5 1.5; 95% CI 1.03–2.5; P 5 0.03) and CD4 count o50 cells/mL (HR 5 9.1; 95% CI 5.1–16.3; Po0.001) were independently associated with death. These results suggest that strategies promoting early diagnosis and better follow-up of addicted patients would have a significant impact on mortality. Keywords: addictions, death, French Guiana, gender, HIV, migrants, risk factors Received: 2 March 2007, accepted 12 June 2007 Introduction French Guiana is the French overseas department where the HIV epidemic is of most concern. There are 38 new AIDS cases per 100 000 inhabitants per year and 41% of pregnant women are HIV positive [1]. French Guiana is a crossroads for poor Caribbean and South American people who emigrate there in search of a better life. Transactional sex is widespread, given the inequalities that exist. Transmission occurs through hetero- sexual sex in over 90% of cases. The standards of healthcare are close to those of mainland France. All HIV-infected patients receive free antiretroviral treatment (including the most recent drugs) regardless of their origin or socio- economic status. Viral loads, CD4 counts, genotyping and antiretroviral concentration measurements are available in routine care. Approximately three-quarters of HIV-infected patients are foreign citizens [2]. They are often diagnosed at more advanced stages of infection and, when diagnosed, they are also more often lost to follow-up (no visit to the clinic for 41 year) than French nationals. Illegal immi- grants who are HIV-positive obtain residence permits when no comparable treatment is available in their country. Although mortality has markedly decreased in French Guiana since the advent of highly active antiretroviral therapy (HAART), AIDS has not disappeared and remains the primary cause of death among infectious diseases. The aim of this study was to determine the predictive factors for death among a cohort of HIV-infected patients in French Guiana since the introduction of HAART. Materials and methods HIV-positive patients followed in Cayenne, Kourou and Saint Laurent du Maroni hospitals between 1 January 1996 and 31 December 2005 were enrolled in the French Hospital Database for HIV (FHDH). Time-independent variables such as sex, nationality and mode of transmission, and time- dependent variables such as age, CD4 counts, HIV-1 viral loads, treatments, and clinical events are routinely entered in the database by trained Clinical Studies Technicians. Patients included in the FHDH give informed consent to the use of their data. Their identity is encrypted before the data are sent to the Ministry of Health and the Institut National de la Recherche Me ´dicale (INSERM) which centralize data from Centres for Information and Care of HIV (CISIH) throughout France. This data collection is approved by the Commission Nationale Informatique et Liberte ´s (CNIL). The data were analysed with STATA 8.0 (StataCorp LP, College Station, TX, USA). Correspondence: Dr Mathieu Nacher, CISIH, Centre Hospitalier Andre ´e Rosemon, Rue des Flamboyants, 97306, Cayenne, French Guiana. Tel: (594) 574 395024; fax: (594) 574 395002; e-mail: m_nacher@lycos.com HIV Medicine (2007), 8, 472–474 r 2007 British HIV Association 472