Incidence and determinants of mortality among HIV infected adult patients on antiretroviral therapy in Ethiopia: A systematic review and Meta-analysis

Abstract

Background Antiretroviral therapy has been highly associated with reduction in the incidence of mortality in HIV/AIDS patients over time. However, there is a regional variation in the extent of reducing the incidence of mortality in many developing countries including Ethiopia. Hence, this study was conducted to generate summary evidences-based data for incidence of mortality and determinants of mortality. Methods Articles were comprehensively searched on Pub Med, Google Scholar, Cochrane library, Scopus, and DOAJ databases using Boolean operators. A Dersimonian and Laird methods of random effect model was used to estimate incidence and determinants of mortality. Heterogeneity, publication bias and quality of each study were checked. Subgroup analysis was employed. Relevant data from each study were extracted. STATA software version 14 was used for all statistical analysis. ResultA total of 21 articles were finally reviewed and analyzed. Incidence of mortality was found to be 5/100-person year of observation (95% CI: 4 – 5/100pyo). Most of the death (67%) occurred during the first year of HAART initiation. Baseline Advanced WHO clinical stage (PHR (Pooled Hazard Rate) 2.88; 95%CI: 2.2 – 3.8), low CD4 cells count (PHR 1.88; 95% CI: 1.5 – 2.4), low body weight (PHR 1.6; 95% CI: 1.2 – 2.2), low hemoglobin level (PHR 2.4; 95% CI: 1.7 – 3.4), presence of TB infection (PHR 2.9; 95% CI: 2.13 – 4.61), non – working functional status (PHR 3.9; 95% CI: 2.8 – 5.4), bad medication adherence (PHR 4.8; 95% CI: 3.2 – 7.2), lack of cotrimoxazole preventive therapy (PHR 1.5; 95% CI: 1.2 – 2.0), being male (PHR 1.4; 95% CI: 1.2 – 1.8) and older age (PHR 1.2; 95% CI: 1.04 – 1.41) were significantly associated with increased mortality in this study. ConclusionIncidence of mortality was high particularly early in the course of therapy. Advanced WHO clinical stage, CD4 cells count low body weight, low hemoglobin level presence of TB infection, bad medication adherence older age and non-working functional status were significant determinants of incidence of mortality. Comprehensive service and strict follow up should be given to avert this high rate of mortality.