Abstract
BackgroundHuman Immunodeficiency Virus (HIV) infection has become a global concern. Determining the factors leading to death among HIV patients helps controlling Acquired Immune Deficiency Syndrome (AIDS) epidemic. Up to now, little is known about mortality and its determinants among people living with HIV in the Middle East and North Africa (MENA) region, including Iran. The purpose of this study was to assess the risk factors of AIDS-Related Mortality (ARM) and Non-AIDS-Related Mortality (NARM) among people with HIV in Iran.MethodsThis 20-year retrospective study was conducted on 1160 people with HIV whose data were collected from 1997 to 2017. The association of the study outcomes (ARM and NARM) with various study variables, including demographic status at the time of diagnosis and clinical indexes during the follow-up were examined to define the predictors of mortality among the patients. Regarding, Cox proportional hazard and competing risk models were fitted and Adjusted Hazard Ratios (AHR), Sub-distribution Hazard Ratio (SHR) and the 95% Confidence Intervals (CI) were reported.Resultsduring the follow-up period, 391 individuals (33.7%) died with 86,375 person-years of follow-up. Of the total deaths, 251 (64.2%) and 140 (35.8%) were ARM and NARM, respectively. Rates of the mortality caused by AIDS and non-AIDS were 3.2 and 4.5 per 1000 person-months, respectively. Responding to combined Antiretroviral Treatment (cART) 6 months after initiation, receiving Pneumocystis Pneumonia (PCP) prophylaxis, and higher CD4 count at diagnosis, reduced the hazard of ARM and NARM. However, older age, late HIV diagnosis, and last HIV clinical stages increased the hazard of AIDS related to mortality. Additionally, male gender, older age, incarceration history, and last HIV clinical stages increased the non-AIDS mortality.ConclusionsMortality caused by AIDS and non-AIDS remains high among people with HIV in Iran, particularly among males and those with late diagnosis. It seems that applying effective strategies to identify infected individuals at earlier stage of the infection, and targeting individuals with higher risk of mortality can decrease the mortality rate among HIV infected people.
Highlights
Human Immunodeficiency Virus (HIV) infection has become a global concern
391 patients (33.7%) died during the study period. Among these cases, 251 were considered as AIDS-Related Mortality (ARM) (64.2%) and 140 of them were considered as Non-AIDS-Related Mortality (NARM) (35.8%)
The CD4 cell count of lower than 200 cells/mm2 was categorized as ARM and otherwise as NARM cCancer: Based on the causes of death in HIV (CoDe) protocol, Acquired Immune Deficiency Syndrome (AIDS)-related cancers like cervical cancer were considered as ARM and other causes unrelated to HIV like lung cancer were categorized as Non-AIDS-Related Death (NARD)
Summary
Human Immunodeficiency Virus (HIV) infection has become a global concern. Determining the factors leading to death among HIV patients helps controlling Acquired Immune Deficiency Syndrome (AIDS) epidemic. ART is expected to help People Living With HIV (PLWH) to have the similar life expectancy to the general population [4, 5]. This goal has not been achieved, yet [6,7,8]. It has been predicted that increase in access to HAART and longer survival time would lead to more variations in the death causes among PLWH [3, 9, 10]. This is due to that as the proportion of ARMs is reducing because of HAART, PLWH are increasingly experiencing Non-AIDSRelated Deaths (NARMs) [11, 12]
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