Incidence and determinants of mortality among HIV infected adult patients on antiretroviral therapy in Ethiopia: A systematic review and Meta-analysis

Abstract

Background Antiretroviral therapy has been highly associated with reduction in the incidence of mortality in HIV/AIDS patients over time. However, there is a regional variation in the extent of reducing the incidence of mortality in many developing countries including Ethiopia. Hence, this study was conducted to generate summary evidences-based data for incidence of mortality and determinants of mortality. Methods Articles were comprehensively searched on Pub Med, Google Scholar, Cochrane library, Scopus, and DOAJ databases using Boolean operators. A Dersimonian and Laird methods of random effect model was used to estimate incidence and determinants of mortality. Heterogeneity, publication bias and quality of each study were checked. Subgroup analysis was employed. Relevant data from each study were extracted. STATA software version 14 was used for all statistical analysis. Result A total of 21 articles were finally reviewed and analyzed. Incidence of mortality was found to be 5/100-person year of observation (95% CI: 4–5/100pyo). Most of the death (67%) occurred during the first year of HAART initiation. Baseline Advanced WHO clinical stage (PHR (Pooled Hazard Rate) 2.88; 95%CI: 2.2–3.8), low CD4 cells count (PHR 1.88; 95% CI: 1.5–2.4), low body weight (PHR 1.6; 95% CI: 1.2–2.2), low hemoglobin level (PHR 2.4; 95% CI: 1.7–3.4), presence of TB infection (PHR 2.9; 95% CI: 2.13–4.61), non – working functional status (PHR 3.9; 95% CI: 2.8–5.4), bad medication adherence (PHR 4.8; 95% CI: 3.2–7.2), lack of cotrimoxazole preventive therapy (PHR 1.5; 95% CI: 1.2–2.0), being male (PHR 1.4; 95% CI: 1.2–1.8) and older age (PHR 1.2; 95% CI: 1.04–1.41) were significantly associated with increased mortality in this study. Conclusion Incidence of mortality was high particularly early in the course of therapy. Advanced WHO clinical stage, CD4 cells count low body weight, low hemoglobin level presence of TB infection, bad medication adherence older age and non-working functional status were significant determinants of incidence of mortality. Comprehensive service and strict follow up should be given to avert this high rate of mortality.

Magnitude and predictor factors of opportunistic infections among adult treatment users at universty of Gondar, 2019

“…Might be due to the presence of invasive diagnostic modalities in specialized referral hospital [13] But less than the study done in south Tigray region, Addis Abeba and Sidama [10,14,15] Might be due to patients coming late to health care service with opportunistic infection before anti-retroviral treatment initiation [16,17].Provisions of cotrimoxazole prophylaxis to the eligible anti-retro viral treatment initiated patients indicated protective to the opportunistic infections than the patients who have no cotrimoxazole prophylaxis was in line with [2,[18][19][20][21]. Might be associated with the treatment of diseases indicating the WHO clinical stage of ART administration and the continuation of prophylaxis as the national ART guideline recommendation reduce opportunistic infections [20] Patients who have base line CLINICAL stage 3 and stage 4 developed opportunistic infections than patients who have BASELINE clinical stage 1and stage 2 condition was in line with the study [14,18,[22][23][24][25] This might be due to low CD4 count to protect the disease, different studies indicated patients who have lowCD4 count vulnerable to opportunistic infections[26-29] Immediate diagnosis and treatment of the opportunistic diseases at the initiation of anti-retro viral treatment, intensive screening eligible patients for supportive treatment and anti-retro viral treatment drug adverse effect is reduce the occurrence of opportunistic diseases [18,30,31].…”

“…The majority of 186 (59%) were female. The median age was 35 years with an interquartile (IQR) of (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) and the median duration of antiretroviral treatment were 42 months with IQR of (32-56). The overall prevalence of opportunistic infections was estimated 21.9% with (95% con dence interval (CI,).Isoniazid preventive therapy coverage was 76.8%.Using logistic regression multivariate analysis with SPSS Cotrimoxazol prophylaxis (AOR=0.24,95% CI = 0.07-0.86)and base line CLINICAL stage(AOR=2.9,95%CI=1.58-5.34),were independent predictors of opportunistic infection.…”

“…The majority of 186 (59%) were female. The median age was 35 years with an interquartile (IQR) of (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) and the median duration of antiretroviral treatment were 42 months with IQR of (32-56). The overall prevalence of opportunistic infections was estimated 21.9% with (95% con dence interval (CI,).…”