Predictors of mortality among HIV infected patients taking antiretroviral treatment in Ethiopia: a retrospective cohort study

Abstract

BackgroundStudies indicate that there is high early mortality among patients starting antiretroviral treatment in sub-Saharan Africa. However, there is paucity of evidence on long term survival of patients on anti-retroviral treatment in the region. The objective of this study is to examine mortality and its predictors among a cohort of HIV infected patients on anti-retroviral treatment retrospectively followed for five years.MethodsA retrospective cohort study was conducted among HIV infected patients on ART in eastern Ethiopia. Cox regression and Kaplan-Meier analyses were performed to investigate factors that influence time to death and survival over time.ResultA total of 1540 study participants were included in the study. From the registered patients in the cohort, the outcome of patients as active, deceased, lost to follow up and transfer out was 1005 (67.2%), 86 (5.9%), 210 (14.0%) and 192 (12.8%) respectively. The overall mortality rate provides an incidence density of 2.03 deaths per 100 person years (95% CI 1.64 - 2.50). Out of a total of 86 deaths over 60 month period; 63 (73.3%) died during the first 12 months, 10 (11.6%) during the second year, and 10 (11.6%) in the third year of follow up. In multivariate analysis, the independent predictors for mortality were loss of more 10% weight loss, bedridden functional status at baseline, ≤ 200 CD4 cell count/ml, and advanced WHO stage patients.ConclusionA lower level of mortality was detected among the cohort of patients on antiretroviral treatment in eastern Ethiopia. Previous history of weight loss, bedridden functional status at baseline, low CD4 cell count and advanced WHO status patients had a higher risk of death. Early initiation of ART, provision of nutritional support and strengthening of the food by prescription initiative, and counseling of patients for early presentation to treatment is recommended.

Mortality of Adults on Antiretroviral Therapy with and without TB coinfection in Jimma University Hospital, Ethiopia: Retrospective Cohort Study

“…Similarly, other studies in Ethiopia [27,31] showed that there is higher mortality in patients with lower baseline functional status similar to the present study. Two other studies in Africa showed that patients who experienced severe morbidity and hence poor performance at presentation to health facilities had higher risks of mortality [32,33] highlighting the need for early presentation and screening for HIV as well as TB of the general population in Africa.…”

“…This finding was comparable to results of two retrospective cohort studies in Eastern Ethiopia [26,27]. This clearly indicates that ART should be initiated as early as possible such as before CD4 counts drop down to 200cells/mm 3 .…”

“…The lower survival rate in cohort with TB observed in this study could be due to the fact that TB patients are more likely to have severe immunosuppression (low CD4 counts), low BMI, and anemia when ART initiated than others. Other studies also complement this fact [18,21,26,27]. Even if the overall survival rate is lower for PLWHs with TB co-infection at the time of ART initiation, the presence of TB co infection was not found to increase the risk of death after accounting for the effect of other confounding factors in Cox-regression model.…”

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

“…Poor adherence leads to clinical failure, resulting in poor CD4 count, giving rise to OIs, and thereby increasing the risk of mortality. Various studies conducted across the globe have reported that poor adherence to ART increases mortality [15,28,29]. The results from our study as well as from similar studies across the world have pointed towards a variety of factors which predict mortality among PLHIV.…”

“…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].…”