Survival and Predictors of Mortality among Adult Patients on Highly Active Antiretroviral Therapy at Debre-Markos Referral Hospital, North West Ethiopia; A Retrospective Cohort Study

Shumey, Ashenif Tadele Ashenafi

doi:10.4172/2155-6113.1000280

Cited by 2 publications

(4 citation statements)

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“…Another important independent prognostic factor of mortality observed in this study was poor/average pattern of adherence to ART, which was also supported by other studies [15, 22]. Careful follow-up of patients with unsatisfactory adherence, timely management of side effects related to ART, and providing them drug counselling for compliance are crucial to improve survival of HIV patients on treatment.…”

Section: Discussionsupporting

confidence: 87%

“…Previous studies using Cox regression analysis identified male gender [14, 15, 19, 23, 24], single marital status [11, 15], bedridden functional status [3, 11–13, 23], advanced WHO clinical stage [3, 8, 11–15, 22–25], underweight [11, 13, 14, 19], low CD4 count [3, 11, 14, 19, 22, 23], severe anaemia [8, 11, 14, 19, 22, 25], and older age [13, 15, 19, 23] as independent risk factors of mortality among PLHIV which was not seen in this study. There was no hazard difference for low and high CD4 count in this study, as three-fourth of the patients had CD4 count ≥200 cells per cu.mm.…”

Section: Discussionmentioning

confidence: 99%

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

Joseph

Sinha

Tiwari

et al. 2019

BioMed Research International

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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.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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

Joseph

Sinha

Tiwari

et al. 2019

BioMed Research International

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“…yes 6 3.10 (1.31, 7.32) 0.010* 94.3 < 0.001 0.068 6 CD4 + T-cell count ( n = 8315) [ 24 , 30 , 37 , 40 – 44 , 47 , 48 , 51 , 55 , 59 , 61 , 63 , 66 ] < 200 vs. ≥ 200 cells/mm 3 16 3.23 (2.29, 4.75) < 0.001* 88.8 < 0.001 0.260 7 Hemoglobin (in gram/dl) ( n = 2745) [ 37 , 39 , 41 – 44 , 47 , 48 , 51 , 53 , 54 , 59 ] < 10 vs. ≥ 10 12 2.63 (1.32, 5.22) 0.006* 94.9 < 0.001 0.692 8 HIV clinical stages ( n = 5581) [ 23 , 30 , 36 , 37 , 40 – 43 , 47 , 48 , 51 , ...…”

Section: Resultsmentioning

confidence: 99%

“…Although there has been no nationally representative summary data, estimates from individual studies conducted in health facilities providing chronic HIV care and treatment services in Ethiopia revealed a person-time incidence rate of mortality between 0.28 deaths per 100 persons per year [ 23 ] in Suhul Hospital in the Tigray region and 22.9 deaths per 100 persons per year in DebreMarkos Referral Hospital in the Amhara region [ 24 ]. To better understand the success of the HIV program in Ethiopia and inform policymakers, we aimed answers to the following questions: (1) What is the pooled person-time incidence rate of mortality among HIV-infected adult patients initiating HAART in Ethiopia?…”

Section: Introductionmentioning

confidence: 99%

Highly active antiretroviral therapy is necessary but not sufficient. A systematic review and meta-analysis of mortality incidence rates and predictors among HIV-infected adults receiving treatment in Ethiopia, a surrogate study for resource-poor settings

Woldegeorgis,

Asgedom,

Habte

et al. 2024

BMC Public Health

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Background Owing to the introduction of highly active antiretroviral therapy (HAART), the trajectory of mortality and morbidity associated with human immunodeficiency virus (HIV) infection has significantly decreased in developed countries. However, this remains a formidable public health challenge for people living with HIV in resource-poor settings. This study was undertaken to determine the pooled person-time incidence rate of mortality, analyze the trend, and identify predictors of survival among HIV-infected adults receiving HAART. Methods Quantitative studies were searched in PubMed, Embase, Scopus, Google Scholar, African Journals Online, and Web of Science. The Joana Briggs Institute critical appraisal tool was used to assess the quality of the included articles. The data were analyzed using the random-effects Dersimonian-Laird model. Results Data abstracted from 35 articles involving 39,988 subjects were analyzed. The pooled person-time incidence rate of mortality (all-cause) was 4.25 ([95% uncertainty interval (UI), 3.65 to 4.85]) per 100 person-years of observations. Predictors of mortality were patients aged ≥ 45 years (hazard ratio (HR), 1.70 [95% UI,1.10 to 2.63]), being female (HR, 0.82 [95% UI, 0.70 to 0.96]), history of substance use (HR, 3.10 [95% UI, 1.31 to 7.32]), HIV positive status non disclosure (HR, 3.10 [95% UI,1.31 to 7.32]), cluster of differentiation 4 + T cell - count < 200 cells/mm3 (HR, 3.23 [95% UI, [2.29 to 4.75]), anemia (HR, 2.63 [95% UI, 1.32 to 5.22]), World Health Organisation classified HIV clinical stages III and IV (HR, 3.02 [95% UI, 2.29 to 3.99]), undernutrition (HR, 2.24 [95% UI, 1.61 to 3.12]), opportunistic infections (HR, 1.89 [95% UI, 1.23 to 2.91]), tuberculosis coinfection (HR, 3.34 [95% UI, 2.33 to 4.81]),bedridden or ambulatory (HR,3.30 [95% UI, 2.29 to 4.75]), poor treatment adherence (HR, 3.37 [95% UI,1.83 to 6.22]), and antiretroviral drug toxicity (HR, 2.60 [95% UI, 1.82 to 3.71]). Conclusion Despite the early introduction of HAART in Ethiopia, since 2003, the mortality rate has remained high. Therefore, guideline-directed intervention of identified risk factors should be in place to improve overall prognosis and increase quality-adjusted life years.

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Survival and Predictors of Mortality among Adult Patients on Highly Active Antiretroviral Therapy at Debre-Markos Referral Hospital, North West Ethiopia; A Retrospective Cohort Study

Abstract: Background: The number of annual acquired immune deficiency syndrome (AIDS)-related deaths worldwide is steadily decreasing. In resource-poor settings, like Ethiopia the treatment was started recently. The survival and factors contributing to mortality are not yet well established.

Cited by 2 publications

References 27 publications

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

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

Highly active antiretroviral therapy is necessary but not sufficient. A systematic review and meta-analysis of mortality incidence rates and predictors among HIV-infected adults receiving treatment in Ethiopia, a surrogate study for resource-poor settings

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