Mortality of HIV-Infected Patients on Antiretroviral Therapy in a Large Public Cohort in West Africa, Burkina Faso: Frequency and Associated Factors

Abstract

Background: In sub Saharan Africa, small size surveys have demonstrated early high mortality among infected patients on antiretroviral therapies (ART). Few studies have been conducted in large cohorts of HIV-patients in public health care system in West Africa. Objectives: Our study aims to determine mortality rate and its predictors in a cohort of patients on ART in a public daycare hospital in Burkina Faso. Methods: We have carried out a retrospective cohort study. All HIV-infected patients on ART between January 1st 2008 and December 31st 2011 were included in the study. Survival probability was estimated by the Kaplan-Meier method. Cox regression analysis was used to identify associated factors to mortality. Results: A total of 2243 HIV-infected patients were included in the study. During the follow-up, 218 patients representing 9.7% were lost. About 104 patients representing 4.6% were transferred and 1691 representing 75.4% were still in the therapeutic cohort. There were 230 death cases for a total of 4282 persons-years, (5.4 deaths for 100 persons-years; 95% CI: 4.8-6.3). The survival probabilities after 6 months, 1 year and 2 years were 92.6%, 91% and 88.9% respectively. For the multivariate analysis, the following factors were independently associated to death: male gender, BMI < 18.5 kg/m 2 , WHO stage 3 and 4, HIV-2, T-CD4 lymphocytes < 200/µl, haemoglobin rate < 8 g/dl and creatinine clearance < 60 ml/m 2. Conclusions: Our study provides for the first time mortality rates and its predictors among HIV-patients on antiretroviral treatment in a large cohort in public health sector in Burkina Faso. It highlights the importance of early HIV screening to limit ART initiation at advanced HIV infection stages.

Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort study

“…This result is in agreement with the study done in Burkina Faso [4]. However, this finding was low compared to common rates in resources-limited countries [5] and higher compared to 2.03/100 persons-years in the Eastern Ethiopia and 1.89/100 persons-years in Western Ethiopia respectively [6, 7].…”

“…This finding is consistent with studies [4, 6, 12, 20, 25, 27]. Studies have substantiated the fact that low CD4 cell count, a marker of advanced immunodeficiency, was associated with opportunistic infection thereby increasing the likelihood of death [28].…”

Predictors of mortality among a cohort of HIV/AIDS patients on anti-retroviral therapy in coastal South India

“…The knowledge of these factors responsible for mortality among PLHIV can guide the policy makers to address them, suggesting and implementing remedial measures through the program. The mortality rate in our study cohort was 14.4%, which was higher than in similar studies conducted in Africa [9][10][11], which is probably due to the higher number of deceased patients in WHO stage 3/4 of the disease in our study.…”

“…Studies from the Sub-Saharan African region have observed a similar trend, with respect to the role of nutrition in PLHIV. Low BMI was associated with mortality in studies from Burkino Faso [9,14], northern Ethiopia [10] and Nigeria [11], where, as in studies from Tanzania [6] and Ethiopia [15], history of significant weight loss, and weight less than 45 kg were predictors of mortality. Poor nutritional status at the initiation of ART and its deterioration within the first 3 months of starting therapy was an important predictor of mortality in another study from Tanzania [16].…”

“…Anaemia as a predictor of mortality was reported in studies from Africa [8,9,14,24,25]. Measuring the laboratory parameters to check for haematological toxicity, hepatotoxicity and renal toxicity before initiation of ART and at periodic intervals is recommended in the National ART guidelines [2].…”