Abstract
Introduction HIV related deaths still continue to occur in large numbers in spite of good quality drugs being freely available in India. This study was therefore done to assess the prognostic factors of mortality among people living with HIV (PLHIV) on antiretroviral therapy (ART). This would help in planning strategies for further improving their survival. Materials and Methods Record based data from baseline and follow-up visits of a cohort of patients aged above 14 years on ART was retrospectively reviewed over a seven-year period. The Kaplan-Meier models were used to estimate life time survival probability, and Cox proportional hazard regression model was used to determine independent prognostic factors of death, among patients, after initiation of ART. Results Mean age of the total 285 patients enrolled in this study was 45.8±9.7 years. Mean duration of treatment on ART was 1127±611.8 days. During the follow-up period, 44/285(15.4%) patients died, resulting in incidence density of death rate as 3.12 per 100 person years. Good adherence with treatment was reported by 267(93.7%) patients. Nearly half of the deaths, i.e., 21(47.7%), occurred within three months of them starting ART. The mean survival time after initiation of ART was 2084.0±55.3 days (95% CI is 1975.5-2192.5). The presence of opportunistic infections (OIs) and tuberculosis before and poor/average adherence to ART and alcohol usage after starting ART were independent prognostic factors of mortality among patients. Conclusion Several prognostic factors influencing mortality among adult HIV patients receiving treatment were identified in this study. Screening efforts is essential in early detection and management of OIs among PLHIV. Good counselling and monitoring is recommended to improve adherence and also to prevent alcohol usage after initiation of ART. Such measures would help in further reducing mortality among HIV patients in the settings.
Highlights
HIV related deaths still continue to occur in large numbers in spite of good quality drugs being freely available in India
With the introduction of Highly Active Antiretroviral Therapy (HAART), there has been a sizable reduction of HIV associated mortality in developing countries [2, 3]
Around 3% and 7% increase of Body mass Index (BMI) from baseline median level was observed after 6 months and 60 months of antiretroviral therapy (ART), respectively
Summary
This study was done to assess the prognostic factors of mortality among people living with HIV (PLHIV) on antiretroviral therapy (ART). This would help in planning strategies for further improving their survival. Good counselling and monitoring is recommended to improve adherence and to prevent alcohol usage after initiation of ART. Such measures would help in further reducing mortality among HIV patients in the settings. The number of deaths due to AIDS related illnesses in India was estimated to be around 62,000 people in the year 2016 [1]. Reasons for the occurrence of so many deaths in 2016 require investigation
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