Abstract
Globally, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) reduces life expectancy by seven years. Mortality is high among non-treated patients in Ethiopia with about 58.1/100 person years of observation. However, the predictors of mortality have not been adequately studied. Hence, the main objective of the study was to determine predictors of mortality among HIV positive adults on antiretroviral treatment in Debremarkos Referral Hospital, Northwest Ethiopia. A facility-based retrospective cohort study design was conducted from September to February, 2013. Data were collected from 640 patients who were enrolled for treatment in Debremarkos Referral Hospital from 2005 to 2013. Proportional hazards Cox model was used to show the independent predictors of the risk of mortality. A total of 261 patients died during the follow up period. Baseline hemoglobin level of < 10 g/mm3 (Adjusted Hazard Ratio (AHR) = 1.86, 95% CI: 1.39 to 2.64), baseline ambulatory functional status (AHR = 2.72, 95% CI: 1.90 to 3.90), bedridden functional status (AHR = 2.38, 95% CI: 1.32 to 4.27), baseline World Health Organization (WHO) staging III and IV (AHR = 2.16, 95% CI: 1.10 to 4.25), recent antiretroviral therapy (ART) adherence (AHR: 2.16, 95% CI: 1.03 to 4.56) and fair adherence (AHR = 1.88, 95%CI: 1.08-3.29) were associated with increased mortality. The risk rate of patients with unexplained chronic diarrhea and without prophylaxis for tuberculosis was increased by 1.53 and 3.98 times compared to patients without diarrhea and treated with tuberculosis prophylaxis, respectively. The mortality rate was high during early phase of treatment especially within the first 6 and 12 months. Baseline hemoglobin < 10 g/mm3, baseline functional status-ambulatory and bedridden functional status, baseline WHO staging (stage III and IV), poor recent antiretroviral therapy adherence, chronic diarrhea and absence of tuberculosis prophylaxis were all significant predictors of mortality. Therefore, patients with the aforementioned predictors should be followed closely and frequently. Key words: Predictors, mortality, HIV positive adults, antiretroviral therapy, Ethiopia.
Highlights
Expanding access of treatment had been contributing by 19% decline of deaths among people who are living with human immunodeficiency virus (HIV) between 2004 and 2009 (Joint United Nations Programme on HIV/AIDS (UNAIDS), 2010)
All HIV positive adults’ record who were on antiretroviral therapy enrolled for treatment from 30th September, 2005 to 30th February, 2013 in Debre Markos Referral Hospital were used for source population, and selected HIV positive adults’ record on care and support follow up who had started ART at the hospital within the same period were included in the study
Between 19th September, 2005 to 30th January, 2008, 5,122 HIV patients were enrolled in Debremarkos Referral Hospital, from which 2,604 were on ART
Summary
Expanding access of treatment had been contributing by 19% decline of deaths among people who are living with human immunodeficiency virus (HIV) between 2004 and 2009 (Joint United Nations Programme on HIV/AIDS (UNAIDS), 2010). A review of 14 cohort studies in high income countries showed that there is still a large discrepancy between the life expectancy of the general population and an HIV-infected individual. The death rates remain higher in HIV-infected individuals than in uninfected individuals, even when successfully treated, and that J. Life expectancy at age 20 is decreased to 18.3 and 11.4 year for men and women who are infected by HIV, respectively (Biadgilign et al, 2012). The overall estimated mortality rate in 12 months post-antiretroviral treatment (ART) initiation is 14%. In sub-Saharan Africa (SSA), most causes of death are tuberculosis (TB), acute sepsis, cryptococca meningitis, malignancies (especially Kaposi’s sarcoma and chronic diarrhea or wasting syndrome (Gupta et al, 2011; Stephen et al, 2008; Johannessen et al, 2008)
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