Incidence of Mortality and Its Predictors Among Adult Human Immune Virus Infected Patients on Antiretroviral Therapy in Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: A Retrospective Follow-Up Study

Abstract

Background: Although the goal of ART is to have better health, extend the life of the HIV-infected patient, and decrease HIV-related death, there is a continuation of HIV-related mortality with the use of ART. This study aimed to assess the incidence of mortality and its predictors among adult HIV/AIDS patients who were on ART follow-up at Wolaita Sodo Comprehensive specialized hospital in southern Ethiopia. Methods: A retrospective follow-up study was conducted from May 1 to June 30, 2021 among adult HIV/AIDS patients with a total of 441 adult HIV/AIDS patients in this hospital included. Kaplan-Meier failure curve and Log rank test were fitted, and Coxproportional hazards model was also used to identify the predictors of mortality. Both crude and adjusted hazard ratios (AHR) with their 95% confidence interval (CI) were calculated to show the strength of association. The proportional assumption was conducted by using a global test based on the Schoenfeld residuals. Results: Incidence of the mortality rate was 5.61 (95% CI, 4.2-7.3) per 100 person-years observation. In the multivariable analysis, HIV/AIDS patients were widowed (aHR; 10.9 (95% CI, 3.13-37.99), poorly drug-adhered (aHR; 5.6 (95% CI, 2.4-13.2) and fair adhered (aHR; 3.53 (95% CI, 1.58-7.87), WHO clinical stage IV (aHR; 5.91, (95% CI, 1.41-24.71), history of substance use (aHR; 2.02 (95% CI, 1.01-4.06) and history of IV drug use (aHR; 2.26 (95% CI, 1.10-4.74) independently predicted the mortality of patients. Conclusion:In this study, incidence of mortality was relatively high. The rate of mortality may be minimized by paying particular attention to individuals with widowing, substance use at the baseline, advanced clinical stage IV, history of IV drug use at the baseline, and those with adherence problems.

Highly active antiretroviral therapy is necessary but not sufficient. A systematic review and meta-analysis of mortality incidence rates and predictors among HIV-infected adults receiving treatment in Ethiopia, a surrogate study for resource-poor settings

“…The participants contributed 91,866.861 PYO, and 4,050 deaths were recorded. Mean or median survival time was reported in 13 of the 35 studies [ 31 , 33 , 34 , 40 , 41 , 43 , 46 , 47 , 53 , 55 , 58 , 59 , 64 ]. There were two subnational studies as part of the Advanced Clinical Monitoring for HIV/AIDS in patients with HIV infection [ 52 , 60 ].…”

“…There were two subnational studies as part of the Advanced Clinical Monitoring for HIV/AIDS in patients with HIV infection [ 52 , 60 ]. Six of the studies were conducted in the Amhara region [ 30 , 42 , 44 , 51 , 54 , 59 ], four in the Oromia region [ 32 – 34 , 55 ]; three in Addis Ababa city administration [ 38 , 43 , 53 ]; 12 in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) [ 31 , 35 , 36 , 39 – 41 , 45 , 46 , 57 , 62 – 64 ], three in Tigray [ 37 , 49 , 50 ], three in Harari region [ 47 , 48 , 61 ], one each in Afar [ 56 ] and Somalia [ 58 ] regions. The overall proportion of mortality was 10.13%, and estimates from individual studies suggest the cumulative incidence of mortality ranged from 4.43% [ 33 ] to 29.68% [ 30 ].…”

“…of studies HR (95% UI) P .value Heterogeneity Egger’s test I 2 (%) P .value P .value 1 Age (in years) ( n = 2446) [ 39 – 42 , 51 , 59 , 65 , 66 ] ≥ 45 vs. < 45 8 1.70 (1.10, 2.63) 0.017* 85.6 < 0.001 0.376 2 Sex ( n = 5581) [ 36 , 37 , 41 , 42 , 48 , 59 , 61 , 63 , 66 – 68 ] Female vs. male 11 0.82 (0.70, 0.96) 0.015* 17.4 0.278 0.147 3 Residence ( n = 7445) [ 36 , 37 , 63 , 65 , 66 , 68 , 69 ] Rural vs. urban 8 1.2 ( 0.77, 2.03) 0.373 89.1 < 0.001 0....…”

“…yes 6 3.10 (1.31, 7.32) 0.010* 94.3 < 0.001 0.068 6 CD4 + T-cell count ( n = 8315) [ 24 , 30 , 37 , 40 – 44 , 47 , 48 , 51 , 55 , 59 , 61 , 63 , 66 ] < 200 vs. ≥ 200 cells/mm 3 16 3.23 (2.29, 4.75) < 0.001* 88.8 < 0.001 0.260 7 Hemoglobin (in gram/dl) ( n = 2745) [ 37 , 39 , 41 – 44 , 47 , 48 , 51 , 53 , 54 , 59 ] < 10 vs. ≥ 10 12 2.63 (1.32, 5.22) 0.006* 94.9 < 0.001 0.692 8 HIV clinical stages ( n = 5581) [ 23 , 30 , 36 , 37 , 40 – 43 , 47 , 48 , 51 , ...…”