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|Title: ||ASSESMENT OF PREDICTORS OF SURVIVAL IN PATIENTS LIVING WITH HIV/AIDS AFTER THE ADVENT OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN ADDIS ABABA ETHIOPIA.|
|Authors: ||ABDO, BEDRU|
|Advisors: ||Dr. ALEMAYEHU WORKU (PhD)|
|Keywords: ||NTIRETROVIRAL THERAPY|
PREDICTORS OF SURVIVAL
|Copyright: ||Jun-2009 |
|Date Added: ||4-May-2012 |
|Abstract: ||BACKGROUND: The introduction of highly active antiretroviral therapy in 1996 dramatically
improved survival and quality of HIV-infected patients in the industrialized world. This survival
benefit of HAART in HIV infection has been well studied in the developed world. In resource-poor
settings, where such treatment was started only recently, limited data exist on treatment results. More
over mortality have been high particularly in the first month of initiating ART and factors
contributing to this high mortality are poorly understood.
OBJECTIVE: To asses predictors of survival in PLWHA after the advent of HAART.
METHODS: A historical cohort study was conducted in Zewditu Hospital located in Addis Ababa,
Ethiopia. Patient’s records enrolled between March, 2005 to July, 2008 were reviewed consecutively
using patients ART unique identification number as a reference. Different documents for the same
patient were triangulated in case of odd values, non logical or missed data. Deaths from all AIDS
related cause occurring during the follow-up period were identified from physician reports or
registration by drug adherence counselor. Univariate analysis was used to describe patient’s baseline
characteristics. Actuarial table was used to estimate survival after intiation of ART, and log rank test
was used to compare survival curves. Cox proportional-hazard regression was used to calculate the
bivariate and adjusted hazard rate and then determine independent predictors of time to death.
RESULT; One thousand seventy patients on ART were followed for a median of 34 month (IQR 6,
36.25). The mean age was 36.4 and the median weight of the cohort at the initiation of ART was
51kg (IQR, 45-60kg).The median CD4 count was 94cells/μl (IQR, 46-154). The estimated mortality
was 24.9%, 29%, 31.7%, 33.1%, 33.5, and 34% at 6, 12, 18, 30, and 48 months respectively. After
adjustment, the independent significant predictors of not surviving in patients living with HIV/AIDS
after initiation of ART remain poor ART adherence (AHR=3.92[95%CI=3.13, 4.90]),Advanced
WHO staging (AHR=2.47[95%CI= (1.58, 3.81]), being unemployed (AHR=1.87[95%CI= 1.49,
2.34]), moderate anemia (AHR=1.86[95%CI=1.35, 2.56), and Low CD4 count (AHR=1.85[95%CI=
CONCLUSION; A careful monitoring of patients with low CD4+ ,advanced WHO staging,
moderate anemia and unemployed particularly during the first 3 months of HAART is necessary.
Tracing poorly adhered patients and giving them drug counseling is crucial to improve their survival.|
|Appears in:||Thesis - Public Health|
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