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

Abstract

Introduction: As the number of patients on anti-retroviral therapy (ART) rises, it is important to identify factors that predict mortality among these patients so that they can be closely monitored. Aim of the study was to determine the mortality rate among a cohort of HIV patients on naive ART and to assess the predictors of mortality among them. Material and methods: In this retrospective study, records of 249 patients living with HIV (PLHIV) who were ART naive, enrolled in the ART centre attached to Kasturba Medical College Hospital, Mangalore from February 2012 to February 2015, were analysed. Univariate and multivariate logistic regression was carried out to assess the factors predicting mortality among these patients. Results: By the end of the study period, 47 out of 249 patients died, giving an overall mortality rate of 18.8%. The mean age of the PLHIV was 43.4 ± 9.1 years. WHO stage 3/4 disease was present in 47.4% of patients. On univariate analysis, mortality was found to be significantly associated with alcohol consumption, being non-ambulatory, underweight (body mass index [BMI] < 18.5 kg/m2), WHO stage 3 or 4 disease, presence of opportunistic infections (OIs), presence of tuberculosis, being on an efavirenz-based regimen, poor adherence (< 95%), CD4 count < 350 cells/mm3, anaemia and raised creatinine levels. However, on multivariate analysis, presence of OIs and low BMI were found to independently predict mortality. Conclusions: Our study identifies lower BMI and presence of OIs as independent risk factors predicting mortality.