Date Published: May 18, 2012
Publisher: BioMed Central
Author(s): Sibhatu Biadgilign, Ayalu A Reda, Tesfaye Digaffe.
Studies indicate that there is high early mortality among patients starting antiretroviral treatment in sub-Saharan Africa. However, there is paucity of evidence on long term survival of patients on anti-retroviral treatment in the region. The objective of this study is to examine mortality and its predictors among a cohort of HIV infected patients on anti-retroviral treatment retrospectively followed for five years.
A retrospective cohort study was conducted among HIV infected patients on ART in eastern Ethiopia. Cox regression and Kaplan-Meier analyses were performed to investigate factors that influence time to death and survival over time.
A total of 1540 study participants were included in the study. From the registered patients in the cohort, the outcome of patients as active, deceased, lost to follow up and transfer out was 1005 (67.2%), 86 (5.9%), 210 (14.0%) and 192 (12.8%) respectively. The overall mortality rate provides an incidence density of 2.03 deaths per 100 person years (95% CI 1.64 – 2.50). Out of a total of 86 deaths over 60 month period; 63 (73.3%) died during the first 12 months, 10 (11.6%) during the second year, and 10 (11.6%) in the third year of follow up. In multivariate analysis, the independent predictors for mortality were loss of more 10% weight loss, bedridden functional status at baseline, ≤ 200 CD4 cell count/ml, and advanced WHO stage patients.
A lower level of mortality was detected among the cohort of patients on antiretroviral treatment in eastern Ethiopia. Previous history of weight loss, bedridden functional status at baseline, low CD4 cell count and advanced WHO status patients had a higher risk of death. Early initiation of ART, provision of nutritional support and strengthening of the food by prescription initiative, and counseling of patients for early presentation to treatment is recommended.
Development of highly active antiretroviral treatment (ART) in the mid-1990s revolutionized the care of HIV-infected patients and led to marked reductions in HIV-associated morbidity and mortality in many industrialized countries [1,2]. ART has clearly shown to be effective in reducing mortality among those who remain in treatment and adhere to therapy [2-4]. In recent years in developing countries with a high burden of AIDS, ART has become more widely available. According to estimation by the World Health Organization (WHO), about 6 650 000 patients were receiving ART in low- and middle-income countries by the end of 2010 , this is a huge improvement from the levels in 2003 [6,7]. Two sub-Saharan African countries, Botswana and Rwanda, have achieved universal access target (treatment coverage of 80% or more of patients in need) at the end of 2009 , while countries such as Ethiopia, Zambia, Namibia and Senegal are moving closer to the same target having covered 50-80% of patients in need of treatment . Due to this morbidity and mortality among HIV-infected persons have dramatically decreased [8,9].
The findings indicate that from the registered cohort, there were 86 deaths in 4234.8 years of retrospective follow up, providing an incidence density of 2.03 deaths per 100 person years (95% CI 1.64–2.51). About 210 (14.0%) patients were lost to follow up. Factors that were associated with mortality were 10% weight loss, bedridden functional status at baseline, ≤200 CD4 cells/ml and advanced stage patients.
All authors declare that they have no competing interest associated with the publication of this manuscript.
AAR and SB contributed significantly in the design, manuscript writing and review. AAR conceived and designed the study, collected data in the field, performed the data analysis, interpreted the data, and drafted the manuscript and critically reviewed it. TD was significantly involved in data collection and has reviewed the manuscript. All authors approved and read the final manuscript.