Assessment of Factors Associated With High Risk of Mortality of HIV Patients Treated With Highly Active Antiretroviral Therapy in Jimma Zone, South Western Ethiopia: Application of Survival Analysis Methods
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Date
2010-09
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Addis Abeba university
Abstract
Background: The introduction of HAART has brought about a significant reduction in the
morbidity and mortality of patients with HIV infection. However, the mortality rate of patients
treated with HAART is still very high in resource-poor settings. Factors contributing to this
high mortality rate are poorly understood.
Objective: The objective of this study is to identify the determinant factors of HIV associated
mortality in a cohort of HIV infected patients treated with HAART.
Method: The study has reviewed patient forms and follow up cards of 832 patients treated
with HAART in Jimma University Specialized Hospital from 2003-2007. The minimum follow
up time was 1 month and the maximum was 78 months. Kaplan-Meier survival curves and
Log-Rank test were used to compare the survival experience of different groups of patients and
proportional hazards Cox model was used to explore the factors associated with increased risk
of mortality.
Results: Some 144 patients died during the follow up time of which 48.6% and 68.8% deaths
occurred within three and six months of HAART initiation, respectively. The overall mean
estimated survival time of patients was 63.7 months. Factors/covariates associated with
increased risk of mortality were older age, (HR=1.03, 95% CI: 1.01-1.051), low CD4 count at
baseline (HR=0.994, 95% CI: 0.992-0.996), low weight at baseline (HR for a 5kg
change=0.902, 95% CI: 0.816-0.996), bedridden and ambulatory functional status (HR=6.904,
95% CI: 4.005-11.902) and (HR=2.877, 95% CI: 1.899-4.360), respectively, co-infection with
TB (HR=1.906, 95% CI: 1.305-2.784) and substance use (HR=1.42, 95% CI: 1.016-1.985).
Conclusion: The mortality rate of patients was high at the earlier time of treatment. Moreover,
laboratory and clinical factors are associated with increased risk of mortality. Thus, those
patients with poor laboratory/clinical characteristics should be identified and treated early
before they progress to advanced disease stages
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Keywords
HIV Patients Treated With Highly Active Antiretroviral