Factors associated with progression from HIV to death in patients receiving antiretroviral therapy in Southern Iran: a 21-year survival analysis and follow-up study

Abstract

Introduction:The expansion of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic has been considered a serious issue globally, and the disease is currently a major contributing factor to morbidity and mortality rates in many developing countries. This study aimed to investigate survival rate of HIV-positive patients, and its' contributing factors among individuals receiving antiretroviral therapy in Southern Iran. Material and methods:A prospective cohort study was conducted among 1,327 HIV patients, who started antiretroviral therapy (ART) between June 2000 and March 2021. Kaplan-Meier analysis and Cox proportional hazard regression analyses were applied to define the survival rate of patients. Results:In this study, of 1,327 registered HIV/AIDS patients who were under ART, 30.6% died during the study period. The 1-, 2-, 5-, and 10-year survival rates of the patients were 90%, 87%, 78%, and 67%, respectively. Based on the results of multivariate Cox regression analysis, older age (HR ≥40/<40 = 1.48), occupation (HR unemployment/employment = 1.29), history of addiction (OR yes/no = 1.64), route of transmission (HR IDU/sexual = 0.48), baseline CD4+ < 200 (HR < 200/> 500 = 2.91), clinical stage IV (HR IV/I = 1.70), ART adherence (HR adherence/non-adherence = 0.37), time on ART > 5 (HR > 5/< 1 = 0.06), and anemia (HR yes/no = 1.58) were directly associated with the survival in patients. Conclusions:Mortality in adults HIV-positive patients on antiretroviral therapy is relatively high in Iran. Age, history addiction, WHO clinical stage, low CD4+ count, and anemia are associated with poor survival in HIV patients. Concerned stakeholders should focus on early detection, timely ART onset, and adherence to treatment.

Predictors of antiretroviral treatment failure to the first line therapy: a cross-sectional study among Iranian HIV-positive adults

“…Moreover, the possible role of unemployment in treatment failure was found among our patients, which showed that unemployment may reduce treatment adherence. A job is a valid characteristic of an individual’s socioeconomic status in society; therefore, unemployment is a risk factor for the incidence of treatment failure [ 61 ].…”