Research Article: High Initial HIV/AIDS-Related Mortality and -Its Predictors among Patients on Antiretroviral Therapy in the Kagera Region of Tanzania: A Five-Year Retrospective Cohort Study

Date Published: September 2, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Kihulya Mageda, Germana Henry Leyna, Elia John Mmbaga.


We examined mortality rates and its predictors from a five years retrospective cohort data of HIV/AIDs patients attending care and treatment clinic in Biharamulo Tanzania. Cox regression analysis was used to identify predictors of mortality. Of the 546 patient records retrieved, the mean age was 37 years with median CD4 count of 156 cells. The mortality rate was 4.32/100 person years at risk with males having three times higher mortality compared to females. Starting Antiretroviral treatment with advanced disease state, body weight below 45 kegs, WHO stage 4 disease, and CD4 cells below 50 were main predictors of mortality. Promoting early voluntary counselling and testing should be given a priority to facilitate timely start of treatment.

Partial Text

By the end of 2010, a total of 34 million people were living with HIV/AIDS worldwide with 2.7 million newly infected in 2010 alone. A total of 1.8 million people died of HIV/AIDS-related death in the same year. Low-and middle-income countries such as those of sub-Saharan Africa are home to 90% of people living with HIV/AIDS globally [1]. The revolution in HIV treatment brought about by combination antiretroviral therapy in 1996 had altered the course of the disease among those living with HIV in high-income countries, but had only reached a fraction of people in low- and middle-income countries [1–3]. Access to antiretroviral therapy in low- and middle-income countries increased from 400 000 in 2003 to 6.65 million in 2010, 47% coverage of people eligible for treatment, resulting in substantial declines in the number of people dying from AIDS-related causes during the past decade. In sub-Saharan Africa 30% fewer death was reported in 2010 as compared to 2004 [1, 4].

The use of antiretroviral therapy has been associated with prolonged survival among people living with HIV/AIDS in the world [1, 12]. The median survival time after ART initiation during the study period was found to be 24 months in this population. This was comparable to what was reported in a study done in Ethiopia by Andinet and Sebastian [13]. However, median survival time in this population was lower than that reported in other studies in the country [14] and that done in Uganda [15]. On the other hand, patients in this study survived longer than those reported in studies conducted in South Africa [16, 17]. These variations indicate that although ART increases survival, it is not the only determinant of survival among people living with HIV/AIDS but could depend on the characteristics of the patients, adherence, and quality of service provision [6, 18].

HIV-related mortality especially among men was high, and mean survival time was relatively low in this population. Majority of patients started ART at a late disease stage characterised by wasting syndrome, lower CD4 cells, and these were associated with higher mortality. Scaling up voluntaray and counselling and testing in the general population as well as through male involvement in reproductive health services would promote early diagnosis and early ART initiation. Further steps to implement the proposed policy on nutrition support among patients on ART would prove beneficial in reducing HIV-related mortality.