Prognostic Factors of Mortality among Adult Patients on Antiretroviral Therapy in India: A Hospital Based Retrospective Cohort Study

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.

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.…”

Low mortality rates at two years in HIV-infected individuals undergoing systematic tuberculosis testing with rapid assays at initiation of antiretroviral treatment in Mozambique

“…These findings indicate that, in general, individuals with and without TB who are able to start adequate treatment may have similar survival (Reepalu et al, 2017), but also suggest that patients with more severe or advanced TB disease may maintain a worse prognosis. The mortality rate observed in co-infected patients in this study is consistent with data from other countries in patients with HIV and TB: 14.2% at 2 years in Mozambique (Blevins et al, 2015), 18.0% at 5 years in Myanmar (Aung et al, 2019), 15.4% at 4 years in India (Joseph et al, 2019), and 13.6% between 2013in Botswana (Tsitenge et al, 2018. The overall mortality rate of 4% in the entire population of patients starting ART is also consistent with the 6% rate observed in a similar population in the Sub-Saharan African countries included in the IeDEA study (Haas et al, 2018).…”

“…The overall mortality rate of 4% in the entire population of patients starting ART is also consistent with the 6% rate observed in a similar population in the Sub-Saharan African countries included in the IeDEA study (Haas et al, 2018). Several of these studies have highlighted that in patients with HIV, most of this additional mortality due to TB co-infection occurs early (Joseph et al, 2019) and is associated with a delay in TB diagnosis and treatment (Lisboa et al, 2019) and in a delayed start of ART (Uthman et al, 2015). In the present study, mortality and missed ART were strictly linked, and missed TB treatment had a similar independent association with mortality among TB co-infected individuals.…”

<p>Survival and Predictors of Mortality Among Adult HIV/AIDS Patients Initiating Highly Active Antiretroviral Therapy in Debre-Berhan Referral Hospital, Amhara, Ethiopia: A Retrospective Study</p>

“…Studies conducted at Fiche hospital in North Showa, Oromia region, Ethiopia, a selected public hospital in Harar, eastern Ethiopia, and India supported that the presence of opportunistic infection increases the probability of death. 16,26,27 This might be because opportunistic infections may increase the risk of mortality in the first few months after initiating ART due to immune reconstitution syndrome, a paradoxical worsening or recurrence of opportunistic infection symptoms as a result of the rapid immunological recovery. 28 The current study revealed that patients with baseline WHO clinical stage III and IV were 2.88-times and 15.6-times more likely to die compared to patients with WHO clinical stage I or II, respectively.…”