Epidemiology of survival pattern and its predictors among HIV positive patients on highly active antiretroviral therapy in Southern Ethiopia public health facilities: a retrospective cohort study

Abstract

Background: In resource poor countries like Ethiopia, little is known about the survival of patients treated with antiretroviral therapy which depends on different factors. Evidence shows that mortality has been high particularly in the first 3 to 6 months of initiating antiretroviral therapy. Hence, the study aimed to assess the Epidemiology of survival pattern and its determinants among adult HIV positive patients on highly active antiretroviral therapy. Methods: Retrospective cohort study was employed among a total of 455 records of patients who were enrolled on antiretroviral therapy from September 2006 to August 2010. Socio-demographic, clinical, immunological, behavioral, and date of antiretroviral treatment initiation including date of follow up status were extracted. Significant predictor variables were identified by fitting Cox's proportional hazard model using a backward stepwise method and statistical significance variables were declared based on a p-value less than 0.05. Results: A total of 455 adult HIV/AIDS patients on ART contributed to 886.05-person-year of observation and 65.7% were alive and on treatment, 17.1% were lost to follow up and 7.5% died. The study showed that the estimated mortality was 4.4%, 5.3%, 6.1%, 7%, 7.5% and 7.5% at 6, 12, 24, 36, 48 and 60 months of follow up period, respectively. The overall incidence rate of mortality was 4.2 per 100 person-years of observation. In multivariate analysis age 45 and above (AHR: 3.72, 95% CI 1.21-11.4), bedridden functional status (AHR: 17.4, 95% CI 6.21-48.79), poor ART drug adherence (AHR: 4.52,95% CI 2.05-9.96), Tuberculosis co-infection (AHR: 4.1, 95% CI 1.84-9.13), non-disclosure (AHR: 4.9, 95% CI 1.82-12.89) and severe anemia (AHR: 5.1, 95% CI 1.81-14.21) were found predictors. Conclusion: Patients with older age, tuberculosis infection, bedridden patients and severe anemia were predictors. Tracing poorly adhered patients and giving drug counseling as well as encouraging them for disclosure to their families is crucial to improve their survival.

Incidence and predictors of mortality within the first year of antiretroviral therapy initiation at Debre-Markos Referral Hospital, Northwest Ethiopia: A retrospective follow up study

“…Patients with baseline ambulatory or bedridden functional status were about two fold at higher risk of death within the first year of HAART as compared to patients with working functional status at enrolment to ART (AHR = 2.18; 95% CI: 1.01, 4.74). This finding is agreed with other studies conducted in different parts of Ethiopia at different time periods, India, and China [20,28,29,[35][36][37][38][39]. This is due to the fact that ambulatory or bedridden functional status is an indicator of low immune status.…”

Predictors of Survival Time Among HIV-Infected Adults After Initiating Anti-Retroviral Therapy in Kombolcha Town: A 5-Year Retrospective Cohort Study

“…Likewise, the hazard of adult mortality was 9.58 times higher among adults with poor drug adherence than adults who had good adherence to ART (AHR=9.58, 95% CI: 8.72–30.97). This is consistent with other studies in Nekemet, 22 Kambata Tambaro Zone 16 (AHR = 3.8, 95% CI: 1.88, 7.96) Goffa zone, 13 Canada. 23 …”

“…In this cohort, 7.65% (95% CI: 5.21–10.42) patients have died. This is in line with other studies in Aksum hospital (8.85%) 8 Oromia region (10.3%), 9 Eastern Ethiopia (5.9%), 10 Tigray central zone (7.5%), 11 Jinka hospital (10%), 12 Gofa zone hospital (7.5%) 13 and Latin America (7.3%). 14 However, this finding is lower than studies in Hiwot Fana teaching hospital (11.9%), 15 Kambata tambaro zone (12.63%), 16 Malawi (12.6%), 17 Durban, South Africa (16%) 18 and India (13%, 16.1%).…”

Survival analysis and predictors of mortality for adult HIV/AIDS patients following antiretroviral therapy in Mizan-Tepi University Teaching Hospital, Southwest Ethiopia: a retrospective cohort study

“…It was found that the patients who started ART in older age (> 45 years) have a 2-fold higher risk of dying than those who baseline age was within 15 and 30 years (AHR = 2.10; 95% CI: 1.41-3.12%). Other studies done across many parts of Ethiopia also reported same results that patients with older age have higher risk of mortality compared to those with younger age patients enrolled on ART [9,11,13,26]. This could be due to the fact that individuals are at higher risk of complications and respond poorly to ART, as a result of combined effect of aging, HIV infection, and antiretroviral treatment.…”

“…The present study has shown that patients having concomitant TB infection had almost a 2-fold higher risk of mortality than those who did not present with concomitant TB infection during follow-up period (AHR = 1.79; 95% CI: 1.39-2.31%). Several studies performed across many parts of Africa and Ethiopia have reported that past TB co-infection at baseline was associated with high level of mortality among patients on ART [9][10][11][12][13][14][15]. Indeed, a study conducted in Cameroon indicated that patients with past TB co-infection showed 2.35-times more risk of death than those who without TB co-infection [16].…”