Mortality and Causes of Death Among HIV-Infected Individuals in the Country of Georgia: 1989–2012

Abstract

Since 2004, the country of Georgia has provided antiretroviral therapy (ART) to all patients in need. A nationwide retrospective cohort study was conducted to assess the effect of universal access to ART on patterns of mortality and causes of death among HIV-infected individuals in Georgia. All known HIV-infected adult individuals (age ‡ 18 years) diagnosed from 1989 through 2012 were included. Rates and causes of death were determined using routinely collected data from the national HIV/AIDS database. Causes of death were classified according to the Coding of Death in HIV (CoDe) protocol. Between 1989 and 2012, 3,554 HIV-infected adults were registered in Georgia contributing to 13,572 person-years (PY) of follow-up. A total of 779 deaths were registered during follow-up. The mortality rate peaked in 2004 with 10.74 deaths per 100 PY (95% CI: 7.92-14.24) and significantly decreased after the universal availability of ART to 4.02 per 100 PY (95% CI: 3.28-4.87) in 2012. In multivariate analysis the strongest predictor of mortality was having AIDS at the time of HIV diagnosis (hazard ratio: 5.69, 95% CI: 4.72-6.85). AIDS-related diseases accounted for the majority of deaths (n = 426, 54.7%). Tuberculosis (TB) was the leading cause of death accounting for 21% of the total deaths reported. Universal access to ART significantly reduced mortality among HIV-infected patients in Georgia. However, overall mortality rates remain high primarily due to late diagnosis, and TB remains a significant cause of death. Improving rates of early HIV diagnosis and ART initiation may further decrease mortality as well as prevent new HIV and TB infections.

Clinical profile and factors associated with mortality in hospitalized patients with HIV/AIDS: a retrospective analysis from Tripoli Medical Centre, Libya, 2013

“…In this study, HAART use was associated with a reduced risk of mortality, a finding consistent with previous reports on improved survival among HIV patients receiving HAART (3,(64)(65)(66). In addition, a presentation with central nervous system symptoms, development of hyponatraemia or a diagnosis of sepsis were independently associated with increased risk of mortality, generally reflecting the severity of underlying diseases (67,68).…”

Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004–2013

“…The mortality rate in our cohort is comparable to that observed in other European studies 2,11,23,24 but much lower than in non-European countries. 5 As mentioned earlier, delayed HIV diagnosis is a major prognostic factor. 4,5,10,11,13 This is especially true regarding premature and HIV/AIDSrelated mortality, as shown here.…”

“…5 As mentioned earlier, delayed HIV diagnosis is a major prognostic factor. 4,5,10,11,13 This is especially true regarding premature and HIV/AIDSrelated mortality, as shown here. In our cohort, 71% of deaths of patients with late presentation and who died within one year of diagnosis were due to HIV/AIDS.…”

Hospital-Based Surveillance for Infectious Etiologies Among Patients with Acute Febrile Illness in Georgia, 2008–2011

“…Since HIV testing was not supported by this study, HIV status was defined based on patient reports. 12,13 Each eligible patient who signed an informed consent or assent form was enrolled in the study. Epidemiologic information was collected through a standardized questionnaire and blood and serum samples were obtained for laboratory determination of infectious agents.…”