Survival Time and Associated Factors Among Adults Living with HIV After Initiation of HAART in South Gondar, Northwest Ethiopia: A Retrospective Cohort

Abstract

Background Antiretroviral therapy consistently improves the survival of people living with HIV and contributes to preventing the development of new infections. Studies of antiretroviral therapy programs in Africa have shown a high mortality rate during the first 6 months after initiation of HAART in rural health facilities. This study looks at survival time and associated factors among adults with HIV in south Gondar, Northwest Ethiopia. Methods A 5-year retrospective cohort study design was conducted using patient records among 746 adults living with HIV/AIDS. A systematic random sampling technique was used to select respondents after proportional allocation was made for all health facilities included in the study. Epi-info version 7 and STATA 12 were used for data entry and analysis, respectively. Kaplan–Meier survival analysis was used to estimate mean survival time and a life table was used to estimate survival probability after initiation of HAART. Results A total of 746 respondents were followed for a median of 60 months. There were 102 (13.67%) deaths yielding an overall mortality rate of 2.59/1,000-person year observation (95% CI=0.02136–0.031736). Age of respondents >43 years (AHR=2.790; 95% CI=1.495–5.206), bedridden (AHR=9.57; 95% CI=3.87–23.64), past TB treatment (AHR=0.86; 95% CI=0.46–0.609), baseline WHO stage IV (AHR=3.02; 95% CI=1.77–5.18), pneumonia after ART start (AHR=3.6; 95% CI=1.4–9.2), INH prophylaxis (AHR=2.58; 95% CI=1.232–5.188), ambulatory functional status (AHR=5.86; 95% CI=2.67–12.86), and disclosure status (AHR=0.423; 95% CI=0.261–0.685) were significant predictors for survival time after initiation of HAART among adults living with HIV. Conclusion The mortality rate was highly (13.67%) observed in the early phase of antiretroviral treatment. Being ambulatory and bedridden, age of respondents >43 years, past TB treatment, baseline WHO stage IV, pneumonia after HAART, INH prophylaxis, and disclosure status were independent predictors of mortality.

Survival and Predictors of Mortality among Adults Initiating Highly Active Antiretroviral Therapy in Ethiopia: A Retrospective Cohort Study (2007-2019)

“…This was not consistent with other study conducted in Ethiopia during the year 2006-2010 that reported 7% mortality at 36 months of follow-up [34]. Other study conducted in Gonder, Ethiopia, in the year 2010-2014 reported mortality at 60 months of follow-up to be 13.67% [8] which is relatively similar to our second HAART cohort, initiating HAART during 2010-2013, that revealed a 10.03% mortality. Despite the study group were children, a study conducted in Gamo Gofa Zone, Ethiopia, conducted from 2009 to 2016 reported mortality in the 60 months of follow-up to be 26.1% which was not in line with our report that showed 4.34% mortality in the year 2014-2016 [16].…”

“…Other study conducted in Ethiopia also revealed being bedridden as 17.4 times risk of death compared to ambulatory patients [ 34 ]. A study conducted in Gonder, Ethiopia, also revealed a 9.57 times risk of death among bedridden [ 8 ]. Our study was consistent with other previous studies and may highlight the importance of early HIV testing and treatment to ensure better survival of PLHIV.…”

“…While disaggregated by the different cohorts, patients with CD4 count of ≤200 cells/mm 3 were at 2.71 (95%CI = 2.01, 3.66), 2.57 (95%CI = 1.93, 3.42), 2.46 (95%CI = 1.60, 3.77), and 2.70 (95%CI = 2.0, 3.64) during 2007-2010, 2011-2013, 2014-2016, and 2017-2019, respectively, compared to those with CD4 count > 200 cells/mm 3 . Studies showed that CD4 count is one of the predictors of mortality in the sense that higher CD4 counts are related to longer survival time [ 8 , 16 , 26 , 34 , 38 , 49 , 50 ]. A study conducted in Jimma University teaching hospital, Ethiopia, indicated that patients who were on ART with CD4 < 200 cells/mm 3 were 1.3 times more likely to die in comparison to those whose CD4 was ≥200 cells/mm 3 .…”

“…∗ Ref. : reference categories were selected as the least risk groups according to the different literatures [ 8 , 9 , 36 , 49 , 50 , 53 ]. ∞ Pooled estimate of aHR (i.e., for the cohorts initiating HAART by 2007 and 2010 for bedridden.…”

“…HIV/AIDS-related mortality of patients may depend on multiple general features including host factors, the patterns of diseases present, access to health care, diagnostic routines, and therapeutic interventions at the local level [5][6][7]. Specific risk factors related to mortality include higher viral load, low CD4 count, regimen intolerance, previous exposure to ARV drugs, malnutrition, medication adherence, missed clinic appointment, TB-HIV coinfection, delayed ART initiation, and age group [3,[8][9][10].…”