Abstract
Background. Study examined the determinants of mortality among adult HIV patients in a rural, tertiary hospital in southeastern Nigeria, comparing mortality among various ART regimens. Methods. Retrospective cohort study of 1069 patients on ART between August 2008 and October 2013. Baseline CD4 counts, age, gender, and ART regimen were considered in this study. Kaplan-Meier method was used to estimate survival and Cox proportional hazards models to identify multivariate predictors of mortality. Median follow-up period was 24 months (IQR 6–45). Results. 78 (7.3%) patients died with 15.6% lost to followup. Significant independent predictors of mortality include age (>45), sex (male > female), baseline CD4 stage (<200), and ART combination. Adjusted mortality hazard was 3 times higher among patients with CD4 count <200 cells/μL than those with counts >500 (95% CI 1.69–13.59). Patients on Truvada-based first-line regimens were 88% more likely to die than those on Combivir-based first line (95% CI 1.05–3.36), especially those with CD4 count <200 cells/μL. Conclusion. Study showed lower mortality than most studies in Nigeria and Africa, with mortality higher among males and patients with CD4 count <200. Further studies are recommended to further compare treatment outcomes between Combivir- and Truvada-based regimens in resource-limited settings using clinical indicators.
Highlights
In 2008, it was estimated that 33.4 million people were living with HIV/AIDS worldwide, with about 70% of those in sub-Saharan Africa [1]
This study was conducted in Nigerian Christian Hospital (NCH), a 110-bed faith-based hospital affiliated with the Church of Christ and International Health Care Foundation
The proportion of patients lost to followup in this study (15.3%) is higher than what has been reported in other African studies such as in Cameroon (5%) and Tanzania (9.7%), but it is comparable to the rates reported in studies conducted in southeastern Nigeria [2, 4]
Summary
In 2008, it was estimated that 33.4 million people were living with HIV/AIDS worldwide, with about 70% of those in sub-Saharan Africa [1]. Following the discovery of the disease in Nigeria in 1986, there has been significant development in efforts to combat HIV/AIDS, including scaling up of antiretroviral treatment (ARTs). This increased the number of people accessing ARTs from 10,000 (2002) to 300,000 (2010) [3]. Males and patients CD4 cell count ≤200 had higher rates of LTFU; this study did not explore the pattern of mortality based on drug treatment. Study examined the determinants of mortality among adult HIV patients in a rural, tertiary hospital in southeastern Nigeria, comparing mortality among various ART regimens. Further studies are recommended to further compare treatment outcomes between Combivir- and Truvada-based regimens in resource-limited settings using clinical indicators
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