Determinants of survival in adult HIV patients on antiretroviral therapy in Oromiyaa, Ethiopia

Bibliographic Data

ID19530906
AuthorsAndinet Worku Alemu, Andinet Alemu (0000-0001-7778-9044, Umeå University), Miguel San Sebastian (0000-0001-7234-3510, Umeå University)
Year2010
Volume3
Issue1
Pages5398
Publication date2010-12-01
Open AccessYes
TypeARTICLE
VenueGlobal Health Action (JOURNAL)
Journal identifiersISSN: 1654-9716 • E-ISSN: 1654-9880
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.3402/gha.v3i0.5398
PMID21042435
PMCIDPMC2967337
OpenAlexW2009016827
LanguageEN
Citations received7
References cited22

BACKGROUND: The antiretroviral treatment (ART) scale-up service has been a recent development in Ethiopia, but its impact on mortality has not been well investigated. The aim of this study was to assess the early survival outcome of the scale-up service by utilizing routine hospital data. METHODS: All adult HIV/AIDS patients who started on antiretroviral treatment in Shashemene and Assela hospitals from January 1, 2006 to May 31, 2006 were included and followed up for 2 years. Data were extracted from standard patient medical registrations. Kaplan-Meier curves were used to estimate survival probability and the Cox proportional hazard model was applied to determine predictors of mortality. Two alterative assumptions (real case and worst case) were made in determining predictors of mortality. RESULTS: The median age of patients was 33 years and 57% were female. Eighty-five percent had CD4 <200 cells/μL with a median CD4 count of 103 cells/μL. The median survival time was 104.4 weeks. A total of 28 (10.3%) deaths were observed during the 2-year period and 48 patients (18%) were lost to follow up. The majority of deaths occurred in the first 4 months of treatment. In multivariate analysis, 2-year survival was significantly associated with the clinical stage of the disease, baseline hemoglobin, and cotrimoxazole prophylaxis therapy (CPT) at or before ART initiation in both assumptions. The median CD4 count and body weight showed a marked improvement during the first 6 months of treatment, followed by stagnation thereafter. CONCLUSION: The study has shown an overall low mortality but a high loss to follow-up rate of the cohort. Advanced clinical stage, anemia, low body weight, and lack of CPT initiation were independent predictors of mortality - but not gender. CPT initiation should be encouraged in routine HIV care services, and patient retention mechanisms have to be strengthened. Stagnation in immunological and weight recovery after the first 6 months should be further investigated. The utilization of routine data should be encouraged in order to facilitate appropriate decision making

Antiretroviral therapy · Confidence interval · Hazard ratio · Multivariate analysis · Proportional hazards model · Survival analysis · Viral load · HIV Research and Treatment · HIV-related health complications and treatments · HIV/AIDS Research and Interventions · Medicine · Immunology · Internal Medicine · Pediatrics

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