Incidence of Mortality and Its Predictors Among HIV Positive Adults on Antiretroviral Therapy in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Teshale, Achamyeleh Birhanu; Tsegaye, Adino Tesfahun; Wolde, Haileab Fekadu

doi:10.2147/hiv.s289794

Cited by 10 publications

(16 citation statements)

References 25 publications

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“…Might be due to the presence of invasive diagnostic modalities in specialized referral hospital [13] But less than the study done in south Tigray region, Addis Abeba and Sidama [10,14,15] Might be due to patients coming late to health care service with opportunistic infection before anti-retroviral treatment initiation [16,17].Provisions of cotrimoxazole prophylaxis to the eligible anti-retro viral treatment initiated patients indicated protective to the opportunistic infections than the patients who have no cotrimoxazole prophylaxis was in line with [2,[18][19][20][21]. Might be associated with the treatment of diseases indicating the WHO clinical stage of ART administration and the continuation of prophylaxis as the national ART guideline recommendation reduce opportunistic infections [20] Patients who have base line CLINICAL stage 3 and stage 4 developed opportunistic infections than patients who have BASELINE clinical stage 1and stage 2 condition was in line with the study [14,18,[22][23][24][25] This might be due to low CD4 count to protect the disease, different studies indicated patients who have lowCD4 count vulnerable to opportunistic infections[26-29] Immediate diagnosis and treatment of the opportunistic diseases at the initiation of anti-retro viral treatment, intensive screening eligible patients for supportive treatment and anti-retro viral treatment drug adverse effect is reduce the occurrence of opportunistic diseases [18,30,31].…”

Section: Discussionsupporting

confidence: 77%

Magnitude and predictor factors of opportunistic infections among adult treatment users at universty of Gondar, 2019

Agezew

Tadesse

Derseh

et al. 2022

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Background: Opportunistic diseases cause morbidity and mortality among human immunodeficiency virus (HIV) infected persons. There is evidence of death on the predictors of opportunistic infections among people living with HIV in the study areas. Objective: This study was conducted to determine the magnitude and predictors of opportunistic diseases among adults enrolled in the University of Gondar specialized Hospital HIV/AIDS care and Treatment services centre. Methods: A hospital-based cross-sectional study was implemented. Simple random sampling methods were employed to select follow-up chart of the patients. A total of 315 medical records were reviewed from University of Gondar specialized referral hospital. Socio-demographic and clinical data including diagnosis of opportunistic diseases were collected from the medical records. Period prevalence of opportunistic diseases over five years of period was determined. Bivariate and multivariate logistic regression was used to determine predictors of opportunistic infections. Results: A total of 315 study participant medical records were reviewed from their follow-up charts. The majority of 186 (59%) were female. The median age was 35 years with an interquartile (IQR) of (30–40) and the median duration of antiretroviral treatment were 42 months with IQR of (32-56). The overall prevalence of opportunistic infections was estimated 21.9% with (95% confidence interval (CI, 17.5-26.3). Isoniazid preventive therapy coverage was 76.8%.Using logistic regression multivariate analysis with SPSS Cotrimoxazol prophylaxis (AOR=0.24,95% CI = 0.07-0.86)and base line CLINICAL stage(AOR=2.9,95%CI=1.58-5.34),were independent predictors of opportunistic infection. Conclusions and recommendations Opportunistic diseases were found to be high among HIV infected adults in Gondar specialized referral hospital. Proactive identification, management, and prevention of opportunistic diseases needs strengthen, especially among females, ambulatory or bed-ridden, and patients with low CD4 cell count.

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Section: Discussionsupporting

confidence: 77%

Magnitude and predictor factors of opportunistic infections among adult treatment users at universty of Gondar, 2019

Agezew

Tadesse

Derseh

et al. 2022

Preprint

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“…The nding from the current study belongs to higher than other studies conducted in Indian public hospitals (23), Nekemte Ethiopia (22). But some studies reported the higher nding of incidence rates compared with the current ndings (4,15,19,20,25,26). This discrepancy in results and the variation in mortality rates between these studies may be due to differences in the clinical characteristics of study participants and differences in study periods (length of follow-up), sample sizes and study settings, as our study included multi-center involvement and we included the patients those who started ART after test and treat strategy.…”

Section: Discussioncontrasting

confidence: 75%

Survival and predictors of mortality among HIV-infected adults after initiation of Anti-Retroviral Therapy in Eastern Ethiopia

Argaw

Gelaye

Lakew

et al. 2023

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Background: Human immune deficiency virus (HIV) remains the leading cause of morbidity and mortality globally. It can lead to AIDS, which results in gradual deterioration and failure of the immune system. As the immune system becomes compromised, the patient becomes highly susceptible to life-threatening infection which ends with early death. Even though antiretroviral therapy (ART) significantly decreases mortality as a whole, the rate of death is still the highest, especially in the first and second years of ART initiation. Objectives: To assess the survival and predictors of mortality among HIV-infected adults after initiation of anti-retroviral therapy in Jigjiga Governmental Hospitals, Eastern Ethiopia. Method: Institution-based Retrospective follow-up study was employed among ART patients from January 1, 2015, to December 31, 2021. Data were cleaned and entered in Epi-data version 3.1 and exported to STATA 14 for further analysis. Kaplan–Meier and Log-Rank tests were applied to compare survival differences among categories of different variables. In bi-variable analysis, p-values < 0.20 were included in a multivariable analysis. A multivariate Cox regression model was used to measure the risk of death & identify the significant predictors of death. Variables that p-value < 0.05 were considered statistically significant predictors of mortality. Result in this study 466(53.34%) participants were male and 552(65.56 %) were urban residents about 91(10.81%) have died with an overall incidence rate of 3.92 (95% CI (2.4–5.4)) per 100-person year of observation. The overall survival probability of the study group was 83.97%. In the multivariable Cox regression analysis, baseline WHO stage III/IV (AHR=2.42(1.43-4.09)) have no caregiver (AHR=2.23; 95% CI (1.16-4.29)), being bedridden functional status (AHR=2.18; 95% CI (1.01-4.72)), and poor last known adherence level (AHR=4.23; 95%CI (2.39-7.47)) were found to be significant predictors of mortality. Conclusion: the incidence of death was relatively high, especially in the second year of ART start. Baseline clinical WHO stage Ⅲ/Ⅳ, bedridden functional status at enrolment, and absence of caregiver, poor level of recent adherence was found to be independent predictors of mortality. Patients with these risk factors need special attention and are crucial to reducing the rate of mortality.

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“…However, our study’s overall mortality rate is higher than the rate reported by a global cohort collaboration across seven regions (0.97 deaths per 100 person-years),35 an African cross-national study (0.8 deaths per 100 person-years)21 and a recent South African community-based ART study (1.2 deaths per 100 person-years) 52. Our estimated mortality incidence is also lower than those found in previous studies of adult PLHIV in Ethiopia, for example, in Gondar (5.3 deaths per 100 person-years),53 Harar (4.8 deaths per 100 person-years),54 Debre Berhan (4.8 deaths per 100 person-years),55 Debre Markos (13.6 deaths per 100 person-years)56 and in Metema (6.7 deaths per 100 person-years) 57…”

Section: Discussioncontrasting

confidence: 46%

“…51 However, our study's overall mortality rate is higher than the rate reported by a global cohort collaboration across seven regions (0.97 deaths per 100 person-years), 35 an African cross-national study (0.8 deaths per 100 personyears) 21 and a recent South African community-based ART study (1.2 deaths per 100 person-years). 52 Our estimated mortality incidence is also lower than those found in previous studies of adult PLHIV in Ethiopia, for example, in Gondar (5.3 deaths per 100 person-years), 53 Harar (4.8 deaths per 100 person-years), 54 Debre Berhan (4.8 deaths per 100 person-years), 55 Debre Markos (13.6 deaths per 100 person-years) 56 and in Metema (6.7 deaths per 100 person-years). 57 The difference between our mortality rate and those reported in previous studies, as well as the variation in mortality rates between these studies themselves, may be due to differences in the clinical characteristics of study participants and differences in study periods, sample sizes and study settings, as our study included only comprehensive specialised hospitals.…”

Section: Discussionmentioning

confidence: 44%

Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis

et al. 2022

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ObjectiveThis study aimed to assess the incidence and predictors of mortality in adolescents receiving antiretroviral therapy (ART) in Ethiopia’s Amhara Region.DesignWe conducted an institution-based retrospective follow-up study.SettingsThe study was conducted at Amhara Region’s comprehensive specialised hospitals in Ethiopia.ParticipantsWe included 961 randomly selected medical records of adolescents receiving ART between January 2005 and June 2020.Primary and secondary outcomesThe incidence of mortality since ART treatment initiation served as the primary outcome, and predictors of mortality served as secondary outcomes. We used Cox proportional hazard regression to examine the relationship between mortality and its predictors. Variables with p values<0.05 in the multivariable analysis were considered statistically significant mortality predictors. Adjusted HR (aHR) with 95% CI was used to measure the strength of association.ResultsMore than half (n=496, 53.5%) of the adolescents living with HIV (ALHIV) were girls. The adolescent mortality rate was 1.52 (95% CI: 1.04 to 1.53) per 100 person-years throughout the follow-up period of 81 583 adolescent months. Mortality was higher for ALHIV who had not received formal education (aHR: 3.27, 95% CI: 1.36 to 7.87), had widowed parents (aHR: 1.85, CI: 95% 1.01 to 3.56) or received no social support (aHR: 2.81, 95% CI: 1.69 to 4.67). Adolescents who had opportunistic infections (OIs) at ART initiation (aHR: 1.94, 95% CI: 1.19 to 3.14), low haemoglobin (Hgb/g/l) levels (aHR: 2.17, 95% CI: 1.08 to 4.18), a bedridden functional status (aHR: 3.11, 95% CI: 1.64 to 5.72), stage IV clinical staging (aHR: 3.03, 95% CI: 1.46 to 6.30), non-disclosing status (aHR: 2.24, 95% CI:1.36 to 3.69) and CD4 count 200–350 cells/mm3(aHR: 2.17, 95% CI: 1.08 to 4.18) also had a higher risk of death. Not receiving cotrimoxazole preventive therapy (aHR: 1.85, 95% CI: 1.07 to 3.22) and poor adherence to ART (aHR: 2.24, 95% CI: 1.27 to 3.95), compared with adherent, was associated with higher mortality risk. Changed treatment regimens were associated with lower mortality (aHR: 0.59, 95% CI: 0.35 to 0.98).ConclusionsOur study found a lower mortality rate for adolescents with HIV than previous Ethiopian studies, but our significant mortality predictors were similar to those found in earlier studies of adults and adolescents. Our findings reveal a potential point for health service improvement in Ethiopia: incorporating monitoring of Hgb levels into patient follow-up care, supporting recommendations that clinicians emphasise managing OIs and providing counselling services to improve adherence.

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Incidence of Mortality and Its Predictors Among HIV Positive Adults on Antiretroviral Therapy in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Cited by 10 publications

References 25 publications

Magnitude and predictor factors of opportunistic infections among adult treatment users at universty of Gondar, 2019

Magnitude and predictor factors of opportunistic infections among adult treatment users at universty of Gondar, 2019

Survival and predictors of mortality among HIV-infected adults after initiation of Anti-Retroviral Therapy in Eastern Ethiopia

Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis

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