Abstract
IntroductionStudies have shown high initial mortality in Antiretroviral Therapy (ART) programs from resource-limited settings. However, there is dearth of evidence on treatment outcomes and associated determinant factors in public hospitals. Therefore, the objective of this study is to assess survival and identify predictors of death in adult HIV-infected patients initiating ART at a public hospital in Eastern Ethiopia.MethodsA retrospective cohort study was conducted by reviewing baseline and follow-up records of patients who started ART between December 1, 2007 and December 31, 2011 at Kharamara hospital. Time to death was the main outcome measure. Kaplan-Meier models were used to estimate mortality and Cox proportional hazards models to identify predictors of mortality.ResultsA total of 784 patients (58.4% females) were followed for a median of 60 months. There were 87 (11.1%) deaths yielding an overall mortality rate of 5.15/100 PYO (95% CI: 4.73-6.37). The estimated mortality was 8.4%, 9.8%, 11.3%, 12.7% and 14.1% at 6, 12, 24, 36 and 48 months respectively. The independent predictors of death were single marital status (AHR: 2.31; 95%CI: 1.18-4.50), a bedridden functional status (AHR: 5.91; 95%CI: 2.87-12.16), advanced WHO stage (AHR: 7.36; 95%CI: 3.17-17.12), BMI < 18.5 Kg/m2 (AHR: 2.20; 95%CI: 1.18-4.09), CD4 count < 50 cells/µL (AHR: 2.70; 95%CI: 1.26-5.80), severe anemia (AHR: 4.57; 95%CI: 2.30-9.10), and TB co-infection (AHR: 2.30; 95%CI: 1.28-4.11).ConclusionImproved survival was observed in patients taking ART in Somali region of Ethiopia. The risk for death was higher in patients with advanced WHO stage, low CD4 count, low Hgb, low BMI, and concomitant TB infection. Intensive case management is recommended for patients with the prognostic factors. Optimal immunologic and weight recoveries in the first 6 months suggest increased effort to retain patients in care at this period.
Highlights
Studies have shown high initial mortality in Antiretroviral Therapy (ART) programs from resource-limited settings
According to the 2012 UNAIDS report, there are an estimated 34 million People Living with HIV (PLHIV) worldwide, Sub-Saharan Africa (SSA) accounting for 69%, with nearly 1 in every 20 adults (4.9%) living with HIV; Around 1.7 million people died from AIDSrelated causes worldwide, 70% occurred in SSA [1]
The result from this study shows patients with a CD4 count of < 50 cells/mL have a higher risk of mortality (AHR: 2.70; 95%CI: 1.265.80) compared to those with a CD4 count of ≥ 200 cells/mL
Summary
Studies have shown high initial mortality in Antiretroviral Therapy (ART) programs from resource-limited settings. The objective of this study is to assess survival and identify predictors of death in adult HIV-infected patients initiating ART at a public hospital in Eastern Ethiopia. Despite increased availability of ARV and promising efficacy reported from ART programs in resourcelimited settings, mortality has been high the first few months after initiating ART [5, 6]. Reporting treatment outcomes of patients enrolled in ART programs is important to demonstrate program effectiveness and justify continued funding, while assessment of factors associated with outcomes can help to identify opportunities for program improvement [7]. There are no studies describing mortality on ART and its associated factors over longer follow up periods. This study determines factors associated with survival and progressive immunologic and weight changes among adult PLHIV receiving ART in Somali region, Ethiopia
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