Assessment of Determinants of Survival in adult HIV Patients after Initiation of Antiretroviral therapy in Nekemte Referral Hospital, Wollega, West Ethiopia. A Retrospective Cohort Study
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Date
2012-05
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Addis Abeba Universty
Abstract
Introduction: Studies identified different determinants of survival which includes, viral load,
WHO clinical staging, CD4 cell count, body mass index (BMI), total lymphocyte count (TLC),
ART adherence and baseline hemoglobin level. Even if these determinants of survival had been
identified, there is no single proven model of determinants for predicting mortality of PLHIV
and these determinants are dynamic and change over time due to improving quality of care and
support and specific interventions like nutritional interventions. Furthermore, the optimal time to
start treatment for HIV/AIDS has been a controversial issue since the introduction of HAART.
Objective: To assess determinants of survival in patients living with HIV after starting ART.
Methodology: A retrospective cohort study was conducted in Nekemte Referral Hospital. A total
of 416 patients’ records enrolled between 2005 to January, 2012 were reviewed consecutively by
using patients’ ART unique identification number as a reference. Univariate analysis was used to
describe patient’s baseline characteristics. Life table was used to estimate survival after initiation
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 determined
independent determinants of time to death.
Results: Four hundred sixteen adult patients on ART were followed for a median of 47 months.
The mean age was 33.6 years (SD=9.04) and the median weight of the study subjects at the
initiation of ART was 51 kg (IQR, 45kg-58kg). The estimated mortality was 4%, 5%, 6%, 7%,
and 7% at 6, 12, 24, 36 and 48 months respectively. After adjustment, factors such as, age≥40
AHR=3.364(1.211, 9.348, p=0.020), lower baseline hemoglobin level AHR=0.490 (0.300, 0.801,
p=.007), and poor ART adherence AHR=132.3(29.9, 585.8, p<0.001) were confirmed as
significant independent determinants of less survival after controlling for other factors while,
single marital status AHR=0.285(0.1, 0.84, p=0.023) was protective of HIV mortality.
Conclusion: This study has identified the independent significant determinants of less survival
in patients living with HIV after initiation of ART which included older age, low baseline
hemoglobin level, and poor ART adherence, while single marital status was protective of HIV
mortality. These determinants should be taken into account by health care providers to enhance
better clinical outcomes.
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Assessment of Determinants of Survival in adult HIV