Determining Factors that Affect the Survival Rate of HIV-Infected Patients on Art: the Case of Armed Forces General Teaching Hospital, Addis Ababa, Ethiopia
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Date
2011-06
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Addis Abeba university
Abstract
Since the first detection of AIDS in Ethiopia, it claims about 67,000 lives of people in 2007. Of
course, the introduction of ART dramatically improved survival and health quality of HIVinfected
patients in the industrialized world; and the survival benefit of ART has been well
studied too. However, in resource-poor settings, where such treatment was started only recently,
limited data exist on treatment results. Moreover, mortality has been high particularly in the first
month of initiating ART and factors contributing to this high mortality are poorly understood.
The study is designed to identify determinant factors (demographic and health related) that affect
the survival of HIV-infected patients in the Ethiopian Armed Forces based on the data from
Armed Forces General Teaching Hospital (AFGTH).
A retrospective cohort study was conducted in AFGTH located in Addis Ababa, Ethiopia.
Records of patients enrolled between September 2003 and August 2007 were reviewed
continuously using patients’ ART unique identification numbers as reference. Kaplan-Meier
survival curves and Log-Rank test were used to compare the survival experience of different
category of patients, and proportional hazards Cox model was employed to identify independent
predictors of mortality. 734 patients on ART were followed for a median of 38.5 months (IQR
10.75, 53). Of these 86 died during the follow up time of whom 28 (32.6%), 43 (50%) and 61
(70.9%) deaths occurred within three months, six months and twelve months of ART initiation,
respectively. The independent predictors of mortality were low CD4 cell count at baseline, (HR
= 0.995, 95% CI: 0.991 - 0.999), ambulatory and bedridden functional status, (HR=2.011,
95%CI: 1.018 - 3.973) and (HR=3.358, 95%CI: 1.734 - 6.500), respectively, WHO clinical
stages III and IV (HR=7.052, 95%CI: 1.677- 29.658) and (HR=12.64, 95%CI: 3.003 - 53.199),
respectively, TB co-infection, (HR=1.734, 95% CI: 1.039 - 2.893) and OIs (HR=8.985, 95% CI:
1.240 - 65.085).
In nut shell, there has been a high mortality of the cohort in the earlier months of treatment.
Thus, a careful monitoring of patients with low CD4 cell count, advanced WHO staging, history
of OIs, co-infection with TB and being employed is necessary in order to improve the survival of
AIDS patients
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Keywords
HIV-Infected Patients on Art