Trends and Predictors of Mortality Among HIV Positive Patients in the Era of Highly Active Antiretroviral Therapy in Uganda

Predictors of survival among older adults with HIV in Uganda's AIDS support organization centers of excellence (1987-2023): a retrospective longitudinal study

BACKGROUND

The growing number of older adults living with HIV, facilitated by wider access to antiretroviral therapy (ART), presents unique challenges. This study aims to identify predictors of survival among older persons living with HIV receiving ART in Uganda's AIDS Support Organization Centers of Excellence (1987-2023). Understanding these predictors can inform effective clinical interventions to improve outcomes for this population.

METHODS

This study conducted a retrospective analysis of medical records from 11 TASO centers of excellence in Uganda (1987-2023). Using Cox proportional hazards regression, we identified factors associated with survival among older adults living with HIV. TASO centers of excellence in Entebbe, Gulu, Jinja, Masaka, Masindi, Mbale, Mbarara, Mulago, Rukungiri, Soroti, and Tororo. Cox proportional hazards regression analysis identified factors influencing survival among older persons living with HIV (OPLHIV).

RESULTS

Of the 30,758 OPLHIV medical records analyzed (1987-2023), 72.5% were active on ART, 5.9% had died, 15.2% were lost to follow-up, and 5.6% transferred to other facilities. Survival was significantly associated with: gender (female, HR = 1.19, p < 0.001), marital status (married, HR = 0.99, p < 0.001; separated/divorced, HR = 0.85, p < 0.001), WHO clinical stage (II, HR = 1.66, p < 0.001), viral load (> 200 copies/ml, HR = 1.49, p < 0.001), and ART adherence (fair, HR = 0.94, p = 0.157).

CONCLUSION

Key predictors of survival among Older Adults Living with HIV (OPLHIV) include: female gender, age 50-59, weight 51-70 kg, married status, viral load > 200 copies/ml, WHO HIV clinical stage II, paid employment, and ART adherence. To improve survival outcomes, consistent clinical screenings of WHO clinical stages, viral load, and ART adherence are essential. These measures can guide healthcare providers in making informed treatment decisions to enhance survival and quality of life for OPLHIV in Uganda.

RECOMMENDATIONS

Strengthen routine monitoring of viral load, ART adherence, and WHO clinical staging. Provide targeted support to married and separated/divorced adults to improve their survival chances. Address gender disparities in care to enhance outcomes for females. Focus on maintaining ART adherence and viral suppression to reduce mortality risks.

Spectrum and trends of cancer among HIV patients in Southwestern Uganda

BACKGROUND

Antiretroviral therapy (ART) restores cellular immunity, significantly reducing AIDS-related mortality and morbidity thus improving the quality of life among People living with HIV (PLHIV). Studies done in several countries show a decline in AIDS defining cancers (ADCs) with the introduction of ART however the increased longevity has led to the increase of Non-AIDS defining cancers (NADCs). The study was aimed at studying the changing spectrum and trends of cancer among Human Immunodeficiency Virus (HIV) patients in southwestern Uganda.

METHODS

The study was a retrospective chart review of records of HIV-positive patients attending/receiving care from the Oncology clinic and ISS clinic of Mbarara Regional Referral Hospital (MRRH) who were, diagnosed with cancer for the past 10 years (January 2012-2021). Data were statistically analyzed using STATA version 17 (Stata Corp, Texas, US) at P <  0.05.

RESULTS

Males were more common at 64.5% while the median age was 37 years (IQR 29-47 years). ADCs were seen in 77.5% of the population while participants with NADCs were older (p < 0.001). The majority 73.3% (283/386) were in later stages (3 and 4). Having either ADCs or NADCs was different across HIV stages (p < 0.001). The median baseline CD4 count was 205 cells/μl (IQR: 90-400 cells/μl). The median duration on ART was 15 months (IQR 3-65 months). Participants with ADCs had been on ART for a shorter duration of time (p < 0.001). Only the outcome of patients with ADCs were available. The outcome varied with sex (p < 0.036), baseline CD4 (p < 0.048), and HIV stage (p < 0.002). Males were more likely to die (30/38 or 78.95%) and lost to follow-up (26/41 or 60.98%). Participants with baseline CD4 cell count > 200 cells/μl were more than twice likely to be active in care. The Commonest ADC was Kaposi Sarcoma (KS) while the commonest NADC was Squamous cell carcinoma, Not otherwise specified. Age above 50 years was associated with a significantly reduced risk of ADCs (OR: 0.11; 95% CI: 0.03-0.43; p value: 0.002). The risk of ADCs increased from stage 2 (OR: 0.46, p-value: 0.03; 95% CI: 0.23-0.91) to stage 3 (OR: 1.13; p-value: 0.66; 95% CI: 0.65-1.97) but this was not statistically significant. The risk of ADCs decreased with increasing ART duration (P value < 0.05).

CONCLUSION

ADCs are still a major health challenge in Southwestern Uganda despite the increasing the coverage and uptake of ART in region. These have mostly affected the young people, people who have been on HAART for a shorter period and those with lower CD4 cell count at initiation of ART.

The estimation of long and short term survival time and associated factors of HIV patients using mixture cure rate models

BACKGROUND

HIV is one of the deadliest epidemics and one of the most critical global public health issues. Some are susceptible to die among people living with HIV and some survive longer. The aim of the present study is to use mixture cure models to estimate factors affecting short- and long-term survival of HIV patients.

METHODS

The total sample size was 2170 HIV-infected people referred to the disease counseling centers in Kermanshah Province, in the west of Iran, from 1998 to 2019. A Semiparametric PH mixture cure model and a mixture cure frailty model were fitted to the data. Also, a comparison between these two models was performed.

RESULTS

Based on the results of the mixture cure frailty model, antiretroviral therapy, tuberculosis infection, history of imprisonment, and mode of HIV transmission influenced short-term survival time (p-value < 0.05). On the other hand, prison history, antiretroviral therapy, mode of HIV transmission, age, marital status, gender, and education were significantly associated with long-term survival (p-value < 0.05). The concordance criteria (K-index) value for the mixture cure frailty model was 0.65 whereas for the semiparametric PH mixture cure model was 0.62.

CONCLUSION

This study showed that the frailty mixture cure models is more suitable in the situation where the studied population consisted of two groups, susceptible and non-susceptible to the event of death. The people with a prison history, who received ART treatment, and contracted HIV through injection drug users survive longer. Health professionals should pay more attention to these findings in HIV prevention and treatment.

Utilization of ART Services Among People Living with HIV During the COVID-19 Pandemic: A Case of Kampala District

Introduction:

The intense pressure on the health system coupled with strict measures have interrupted ART service utility during the COVID 19 pandemic. In this study, we assessed the Utilization of ART services among People Living with HIV during the COVID-19 pandemic in Kampala District, Uganda.

Methods:

We studied 9952 records of patient encounters between 24th March and 1st June 2020 from the Open Medical Records System (EMR) and obtained an analytical sample of 647 encounters for PLHIV enrolled in Kampala district; 243 from the Mbuya site, 274 from Kinawataka site and 130 from Banda site. We assessed factors associated with inadequate ART utilization using the modified poison regression (generalized linear model with a poisoned family and a log link) and reported clustered robust standard errors with their corresponding Prevalence Ratios.

Results and Discussion:

The rate of ART utilization during the COVID-19 pandemic in the Kampala district was inadequate (14.71%). PLHIV who were in WHO clinical stage 3 had aPR=18.065, 95%CI=17.396 18.759, and P-value =0.001 as compared to those in WHO stage 1. PLHIV who were obese had aPR=1.439, 95% CI=1.103 1.879, P-value =0.007 as compared to those with normal BMI.

Conclusion:

The factors associated with inadequate ART utilization were body mass index and WHO clinical staging of the disease. This information is crucial for strengthening HIV programs and interventions in terms of access to ART services, with a focus on obese infected individuals and those with advanced HIV disease during pandemics that require lock-down measures.

Mortality and Its Predictors among Adult Human Immune-Deficiency Virus-Infected Patients Attending Their Antiretroviral Treatment at Health Centers, Addis Ababa, Ethiopia: Multicenter Retrospective Cohort Study

Introduction

In resource-limited settings such as Ethiopia, where the prevalence of HIV/AIDS is high, a number of factors, including economic, demographic, behavioral risk, and health factors, affect how long people with AIDS are treated with antiretroviral therapy. Since several aspects of the clinical setup may have an impact on ART patients' survival, this study was conducted in health centers. Determining the mortality rate and survival factors among adult HIV-infected patients receiving ART at health centers in Addis Abeba's Kirkos subcity is the primary goal of this study.

Methods

A retrospective cohort study was carried out at the health center in Addis Abeba's Kirkos subcity. The source population consisted of all adult HIV-positive patients who were being followed up between December 1, 2014, and October 30, 2019. A total of 665 samples were collected using a computer-generated simple random sampling method in each of the three health centers that were chosen by a lottery system depending on the number of patients in the follow-up. Trained data collectors took the information out of the patient card and the electronic database. Regressions using the Kaplan‐Meier and Cox proportional hazards were employed.

Results

The incidence of death rate in adult HIV-positive patients was 55 (8.5%) fatalities, translating to a death rate of 3.25 per 100 person-years. The majority of deaths occurred within 6 months of ART initiation. Predictors of mortality were: age above 50 years (AHR = 4.90, 95% CI: 2.00, 11.98), tuberculosis comorbidity (AHR = 3.46, 95% CI: 1.23, 3.33), lack of drug adherence (AHR = 1.76, 95% CI: 1.23, 3.33), co-trimoxazole therapy (AHR = 2.59, 95% CI: 1.37, 4.90), and CD4 cell count less than 200/dl (AHR = 2.77, 95% CI: 1.30, 5.92). Conclusion and Recommendation. Adult HIV-positive individuals had an incidence of the death rate of 55 (8.5%), which equates to 3.25 deaths per 100 person-years. Age category over 50, TB comorbidity, WHO stage IV, lack of medication adherence, co-trimoxazole therapy, body mass index under 18.5 kg/m², and CD4 cell count under 200/dl were predictors of mortality. Therefore, it is important to focus on prevention, early identification, and treatment of HIV/AIDS for these predictors at all levels of the HIV/AIDS chronic care package in order to increase survival.

Predictors of mortality among people living with HIV in the test and treat era within rural Uganda: a retrospective cohort study

Background: Uganda adopted the test and treat strategy in 2016 where all people living with HIV are initiated on antiretroviral drugs irrespective of CD4 count and WHO clinical stage, as one of the major strategies to end the HIV epidemic by 2030. Despite these measures, there are still more than 2 000 HIV-related death annually. The study aim was to determine the mortality rate and factors predictive of mortality in the test and treat era among people living with HIV in rural Uganda.Methods: We conducted a retrospective cohort study among people living with HIV enrolled into care between January 2016 and December 2020 at Kabwohe Clinical Research Centre in south-western Uganda. Kaplan-Meier curves were used for survival analysis and Cox regression analysis at bivariate and multivariable levels was used to determine the adjusted hazard ratios (AHR) and identify predictors of death during the study period.Results: Of the 976 participants included in the study, 57.1% (557) were females while 42.9% (419) were males. The median age of the participants was 35 years. The average follow-up period was 2.9 years with an overall mortality rate of 0.99 per 100 person-years at risk. In multivariate analysis, the independent predictors for mortality were: CD4 < 200cells/mm³ (AHR 3.68; 95% CI 1.7-8.1), viral load ≥ 1 000 copies/ml (AHR 5.22; 95% CI 2.4-11.4) and a non-optimised antiretroviral regimen (AHR 4.08; 95% CI 1.5-0.8).Conclusion: There was a low mortality rate observed in this study with a higher risk of death associated with advanced HIV disease and unsuppressed initial viral load. The findings of the study therefore support efforts in early antiretroviral therapy initiation as it increases the likelihood of people living with HIV surviving and can accelerate efforts in ending the HIV epidemic by 2030.

Development and internal validation of the HIV In-hospital Mortality Prediction (HIV-IMP) risk score

BACKGROUND

Despite advances in availability and access to antiretroviral therapy (ART), HIV still ranks as a major cause of global mortality. Hence, the aim of this study was to develop and internally validate a risk score capable of accurately predicting in-hospital mortality in HIV-positive patients requiring hospital admission.

METHODS

Consecutive HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital adult emergency department between 7 July 2017 and 18 October 2018 were prospectively enrolled. Multivariate logistic regression was used to determine parameters for inclusion in the final risk score. Discrimination and calibration were assessed by means of the area under the receiver operating curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test, respectively. Internal validation was conducted using the regular bootstrap technique.

RESULTS

The overall in-hospital mortality rate was 13.6% (n = 166). Eight predictors were included in the final risk score: ART non-adherence or not yet on ART, Glasgow Coma Scale < 15, respiratory rate > 20 breaths/min, oxygen saturation < 90%, white cell count < 4 × 10⁹ /L, creatinine > 120 μmol/L, lactate > 2 mmol/L and albumin < 35 g/L. After internal validation, the risk score maintained good discrimination [AUROC 0.83, 95% confidence interval (CI): 0.78-0.88] and calibration (Hosmer-Lemeshow χ² = 2.26, p = 0.895).

CONCLUSION

The HIV In-hospital Mortality Prediction (HIV-IMP) risk score has overall good discrimination and calibration and is relatively easy to use. Further studies should be aimed at externally validating the score in varying clinical settings.

Predictors of All-Cause Mortality among People with HIV in a Prospective Cohort Study in East Africa and Nigeria

Background

Introduction of antiretroviral therapy (ART) has been associated with a decline in human immunodeficiency virus (HIV)-related mortality, although HIV remains a leading cause of death in sub-Saharan Africa. We describe all-cause mortality and its predictors in people living with HIV (PLWH) in the African Cohort Study (AFRICOS).

Methods

AFRICOS enrolls participants with or without HIV at 12 sites in Kenya, Uganda, Tanzania, and Nigeria. Evaluations every 6 months include sociobehavioral questionnaires, medical history, physical examination, and laboratory tests. Mortality data are collected from medical records and survivor interviews. Multivariable Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for factors associated with mortality.

Results

From 2013 through 2020, 2724 PLWH completed at least 1 follow-up visit or experienced death. Of these 58.4% were females, 25.8% were aged ≥ 50 years, and 98.3% were ART-experienced. We observed 11.42 deaths per 1000 person-years (95% CI: 9.53–13.68) with causes ascertained in 54% of participants. Deaths were caused by malignancy (28.1%), infections (29.7%), and other non-HIV related conditions. Predictors of mortality included CD4 ≤ 350 cells/µL (aHR 2.01 [95% CI: 1.31–3.08]), a log₁₀copies/mL increase of viral load (aHR 1.36 [95% CI: 1.22–1.51]), recent fever (aHR 1.85[95% CI: 1.22–2.81]), body mass index < 18.5 kg/m2 (aHR 2.20 [95% CI: 1.44–3.38]), clinical depression (aHR 2.42 [95% CI: 1.40–4.18]), World Health Organization (WHO) stage III (aHR 2.18 [95% CI: 1.31–3.61]), a g/dL increase in hemoglobin (aHR 0.79 [95% CI: .72–.85]), and every year on ART (aHR 0.67 [95% CI: .56–.81]).

Conclusions

The mortality rate was low in this cohort of mostly virally suppressed PLWH. Patterns of deaths and identified predictors suggest multiple targets for interventions to reduce mortality.

Clinical Signs and Laboratory Parameters as Predictors of Mortality among Hospitalized Human Immunodeficiency Virus-Infected Adult Patients at Tertiary Hospital in Surabaya

BACKGROUND: The morbidity and mortality rates due to human immunodeficiency virus (HIV) infection are still high despite various and advanced efforts in the management given for HIV/AIDS patients. AIM: This study proposed that clinical signs and laboratory parameters could be expected to predict the patient’s mortality. METHODS: This retrospective study was done by collecting 408 medical records of adult HIV/AIDS inpatients at a tertiary hospital in Surabaya from January 1, 2017, to December 31, 2019. Bivariate analysis using Chi-square test was carried out on nine variables, which were Glasgow Coma Scale (GCS) <15, hypotension, PaO2/FiO2 <400 mmHg, elevated liver enzymes, hemoglobin levels <10 mg/dl, platelet count <150,000/mm3, eGFR <60 ml/min/1.73 m2, albumin levels <3.5 mg/dl, and body mass index (BMI) <18.5 kg/m2. Variables which met the criteria would be included in the multivariate analysis using logistic regression. RESULTS: Based on bivariate analysis, mortality was found to be significantly associated with GCS <15, hypotension, PaO2/FiO2, elevated liver enzymes, platelet count <100,000 mm3, eGFR <60 ml/1.73kg/m2, albumin levels <3.5 mgdl, and BMI <18.5 kg/m2. However, based on multivariate analysis, there were five variables which were found to be able to independently predict the patients’ mortality, those were GCS <15 (OR 11.625), hypotension (OR 6.062), PaO2/FiO2< 400 mmHg (OR 7.794), eGFR <60 ml/min/1.73 m2 (OR 2.646), and albumin levels <3.5 mg/dl (OR 4.091). CONCLUSION: GCS <15, hypotension, PaO2/FiO2 <400 mmHg, eGFR <60 ml/1.73g/m2, and albumin levels <3.5 mg/dl were found as the independent risk factors which could predict the hospitalized HIV/AIDS patients’ mortality.

Predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy in Metema Hospital, Northwest Ethiopia: a retrospective follow-up study

Background

Globally Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is an ongoing public health issue associated with high morbidity and mortality. Efforts have been made to reduce HIV/AIDS-related morbidity and mortality by delivering antiretroviral therapy. However, the incidence and predictors of mortality in border areas like Metema were not investigated. This study aimed to assess predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy at Metema Hospital.

Methods

Retrospective follow-up study was employed among ART patients from January 1, 2013, to December 30, 2018. Data were entered in Epi-data 3.1 and exported to STATA 14 for analysis. Kaplan–Meier and Log-Rank test was used to compare survival differences among categories of different variables. In bi-variable analysis p-values < 0.20 were entered into a multivariable analysis. Multivariate Weibull model was used to measure the risk of death and identify the significant predictors of death. Variables that were statistically significant at p-value < 0.05 were concluded as predictors of mortality.

Result

A total of 542 study participants were included. The overall incidence rate was 6.7 (95% CI: 5.4–8.4) deaths per 100 person-years of observation. Being male (HR = 2.4; 95% CI: 1.24–4.62), STAGE IV (HR = 5.64; 95% CI: 2.53–12.56), stage III (HR = 3.31; 95% CI: 1.35–8.10), TB-coinfection (HR = 3.71; 95% CI: 1.59–8.64), low hemoglobin (HR = 4.14; 95% CI: 2.18–7.86), BMI ≤ 15.4 kg/m² (HR = 2.45; 95% CI: 1.17–5.10) and viral load > 1000 copy/ml (HR = 6.70; 95% CI: 3.4–13.22) were found to be a significant predictor for mortality among HIV patients on ART treatment.

Conclusion

The incidence of death was high. Being male, viral load, those with advanced STAGE (III & IV), TB co-infected, low BMI, and low hemoglobin were at a higher risk of mortality. Special attention should be given to male patients and high public interventions needed among HIV patients on ART to reduce the mortality rate.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12981-021-00353-z.

Predictors of in-hospital mortality among HIV-positive patients presenting with an acute illness to the emergency department

OBJECTIVES

Despite better access to antiretroviral therapy (ART) over recent years, HIV remains a major global cause of mortality. The present study aimed to identify predictors of in-hospital mortality among HIV-positive patients presenting to an emergency department (ED).

METHODS

In this cross-sectional study, HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital adult ED between 07 July 2017 and 18 October 2018 were prospectively enrolled. Data were compared between participants who survived to hospital discharge and those who died. The data were further subjected to univariate and multivariate logistic regression analyses to determine variables that were associated with in-hospital mortality.

RESULTS

Of a total of 1224 participants, the in-hospital mortality was 13.6% (n = 166). On multivariate analysis, respiratory rate > 20 breaths/min [odds ratio (OR) = 1.90, P = 0.012], creatinine > 120 μmol/L (OR = 1.97, P = 0.006), oxygen saturation < 90% (OR = 2.09, P = 0.011), white cell count < 4.0 × 10⁹ /L (OR = 2.09, P = 0.008), ART non-adherence or not yet on ART (OR = 2.39, P = 0.012), Glasgow Coma Scale < 15 (OR = 2.53, P = 0.000), albumin < 35 g/L (OR = 2.61, P = 0.002), lactate > 2 mmol/L (OR = 4.83, P = 0.000) and cryptococcal meningitis (OR = 6.78, P = 0.000) were significantly associated with in-hospital mortality.

CONCLUSIONS

Routine clinical and laboratory parameters are useful predictors of in-hospital mortality in HIV-positive patients presenting to the ED with an acute illness. These parameters may be of value in guiding clinical decision-making, directing the appropriate use of resources and influencing patient disposition, and may also be useful in developing an outcome prediction tool.

Incidence of Mortality and Its Predictors Among HIV Positive Adults on Antiretroviral Therapy in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Background

Despite the accessibility and higher coverage of antiretroviral therapy (ART), HIV/AIDS is a leading cause of morbidity and mortality in low- and middle-income countries. Ethiopia also shares the high burden of HIV/AIDS-related morbidity and mortality. Therefore, this study aimed to assess the incidence of mortality and its predictors among adult HIV patients on ART in the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia.

Patients and Methods

A retrospective follow-up study was conducted from January 2015 to January 2019 at the University of Gondar Comprehensive Specialized Hospital. A total of 475 patients who were on follow-up in this Hospital were included. The Cox proportional hazard model was fitted to assess the predictors of mortality. Both crude and adjusted hazard ratio (AHR) with their 95% confidence interval (CI) were calculated to show the strength of association. In multivariable analysis, variables with a P-value <0.05 were considered as statistically significant predictors of mortality.

Results

In this study, a total of 45 (9.5%) patients died with an incidence rate of 5.3 [95% CI: 3.4–7.1] per 100 person-years of observation. In the multivariable Cox regression analysis, the last known WHO stage III/IV [AHR= 15.02; 95% CI: 5.79–38.92], being anemic at baseline [AHR = 2.21; 95% CI: 1.02–4.78], and fair last known adherence level [AHR = 3.29; 95% CI: 1.39–7.78] were found to be significant predictors of mortality.

Conclusion

In this study, the incidence of mortality was relatively high. The rate of mortality may be minimized by paying particular attention to individuals with advanced WHO stage, anemia at the baseline, and those with adherence problems.

HIV-Related Deaths in Nairobi, Kenya: Results From a HIV Mortuary Surveillance Study, 2015

BACKGROUND

Death is an important but often unmeasured endpoint in public health HIV surveillance. We sought to describe HIV among deaths using a novel mortuary-based approach in Nairobi, Kenya.

METHODS

Cadavers aged 15 years and older at death at Kenyatta National Hospital (KNH) and City Mortuaries were screened consecutively from January 29 to March 3, 2015. Cause of death was abstracted from medical files and death notification forms. Cardiac blood was drawn and tested for HIV infection using the national HIV testing algorithm followed by viral load testing of HIV-positive samples.

RESULTS

Of 807 eligible cadavers, 610 (75.6%) had an HIV test result available. Cadavers from KNH had significantly higher HIV positivity at 23.2% (95% CI: 19.3 to 27.7) compared with City Mortuary at 12.6% (95% CI: 8.8 to 17.8), P < 0.001. HIV prevalence was significantly higher among women than men at both City (33.3% vs. 9.2%, P = 0.008) and KNH Mortuary (28.8% vs. 19.0%, P = 0.025). Half (53.3%) of HIV-infected cadavers had no diagnosis before death, and an additional 22.2% were only diagnosed during hospitalization leading to death. Although not statistically significant, 61.9% of males had no previous diagnosis compared with 45.8% of females (P = 0.144). Half (52.3%) of 44 cadavers at KNH with HIV diagnosis before death were on treatment, and 1 in 5 (22.7%) with a previous diagnosis had achieved viral suppression.

CONCLUSIONS

HIV prevalence was high among deaths in Nairobi, especially among women, and previous diagnosis among cadavers was low. Establishing routine mortuary surveillance can contribute to monitoring HIV-associated deaths among cadavers sent to mortuaries.

Prognostic Factors of Mortality among Adult Patients on Antiretroviral Therapy in India: A Hospital Based Retrospective Cohort Study

INTRODUCTION

HIV related deaths still continue to occur in large numbers in spite of good quality drugs being freely available in India. This study was therefore done to assess the prognostic factors of mortality among people living with HIV (PLHIV) on antiretroviral therapy (ART). This would help in planning strategies for further improving their survival.

MATERIALS AND METHODS

Record based data from baseline and follow-up visits of a cohort of patients aged above 14 years on ART was retrospectively reviewed over a seven-year period. The Kaplan-Meier models were used to estimate life time survival probability, and Cox proportional hazard regression model was used to determine independent prognostic factors of death, among patients, after initiation of ART.

RESULTS

Mean age of the total 285 patients enrolled in this study was 45.8±9.7 years. Mean duration of treatment on ART was 1127±611.8 days. During the follow-up period, 44/285(15.4%) patients died, resulting in incidence density of death rate as 3.12 per 100 person years. Good adherence with treatment was reported by 267(93.7%) patients. Nearly half of the deaths, i.e., 21(47.7%), occurred within three months of them starting ART. The mean survival time after initiation of ART was 2084.0±55.3 days (95% CI is 1975.5-2192.5). The presence of opportunistic infections (OIs) and tuberculosis before and poor/average adherence to ART and alcohol usage after starting ART were independent prognostic factors of mortality among patients.

CONCLUSION

Several prognostic factors influencing mortality among adult HIV patients receiving treatment were identified in this study. Screening efforts is essential in early detection and management of OIs among PLHIV. Good counselling and monitoring is recommended to improve adherence and also to prevent alcohol usage after initiation of ART. Such measures would help in further reducing mortality among HIV patients in the settings.

Prevalence and Risk Factors of Active TB among Adult HIV Patients Receiving ART in Northwestern Tanzania: A Retrospective Cohort Study

INTRODUCTION

Although ART has improved the outcome of people living with HIV/AIDS, still some patients develop TB while receiving ART. The literature on the magnitude of this problem is still scarce in our setting especially northwestern Tanzania. This study was designed to determine the prevalence of active TB among HIV patients on ART and assess its potential risk factors.

METHODS

A retrospective cohort study was done among adult HIV-positive patients initiated on ART at Bugando Medical Centre. Patients who were TB positive before ART initiation were excluded. Data regarding demographic, clinical, and laboratory information, TB status on receipt of ART, and time on ART were collected and analyzed using STATA 11 to determine the prevalence of TB and its associated factors.

RESULTS

In total, 391 patients were enrolled in this study. The median age was 39 (32-46) years, and a total of 129 (32.99%) participants had CD4 counts <200 cells/µl and 179 (45.78%) had WHO stage 3 and 4 illnesses. A total of 43 (11.0%) participants developed TB while receiving ART which was independently associated with male gender (OR = 2.9; p=0.007), WHO clinical stage 3 and 4 (OR = 1.4; p=0.029), baseline CD4 count <200 cells/µl (OR = 9.1; p < 0.001), and having not used IPT (OR = 3.1; p=0.05).

CONCLUSIONS

Active TB is prevalent among HIV patients while receiving ART in northwestern Tanzania which is independently associated with male gender, advanced HIV disease, and nonuse of IPT. Universal HIV testing could reduce late HIV diagnosis and hence reduce the risk of developing TB while receiving ART in our setting. Also IPT should be widely used for those who are negative for TB on screening.

Mortality and Its Predictors among HIV Infected Patients Taking Antiretroviral Treatment in Ethiopia: A Systematic Review

Background

Even though the benefit of antiretroviral therapy (ART) is well established, there is a regional variation in the extent of its benefit. The aim of this review is to highlight mortality and its predictors in Ethiopian adult HIV patients who were on ART.

Methods

Relevant articles were searched on PubMed and Google Scholar databases. The search terms used in different combinations were predictor/determinant/factors, mortality/death/survival, HIV, ART/HAART, and Ethiopia.

Result

5-40.8% of the patients died during the follow-up period. More than half (50-68.8%) of the deaths occurred within 6 months of initiating ART. Advanced stage disease (stage III and stage IV), nonworking functional status (bedridden and ambulatory), low baseline CD4 count, low baseline hemoglobin level, TB coinfection, lower baseline weight, and poor treatment adherence were commonly identified as predictors of death in HIV patients.

Conclusion

5-40.8% of HIV patients in Ethiopia die in 2-5 years of initiating antiretroviral treatment. Most of the deaths in HIV patients occur early in the course of treatment. Special emphasis should be given for patients with advanced stage disease, nonworking functional status, low baseline CD4 count, low baseline hemoglobin level, TB coinfection, lower baseline weight, and poor treatment adherence.

Disclosure of Parental HIV Status to Children: Experiences of Adults Receiving Antiretroviral Treatment at an Urban Clinic in Kampala, Uganda

Limited data are available on the experiences of parental HIV disclosure to children in Uganda. We conducted a qualitative study comprising sixteen in-depth interviews and four focus group discussions with parents receiving highly active antiretroviral therapy. Analysis was done using Atlas.ti qualitative research software. Back-and-forth triangulation was done between transcripts of the in-depth interviews and focus group discussions, and themes and subthemes were developed. Barriers to parents' disclosure included perceptions that children are too young to understand what HIV infection means and fears of secondary disclosure by the children. Immediate outcomes of disclosure included children getting scared and crying, although such instances often gave way to more enduring positive experiences for the parents, such as support in adherence to medical care, help in household chores, and a decrease in financial demands from the children. Country-specific interventions are needed to improve the process of parental HIV disclosure to children and this should encompass preparation on how to deal with the immediate psychological challenges associated with the parent's disclosure.

The effect of stage of HIV disease as determined by CD4 count on clinical outcomes of surgical sepsis in South Africa

INTRODUCTION This paper reviews the impact of the stage of human immunodeficiency virus (HIV) disease on the outcome of surgical sepsis. METHODS All adult emergency general surgical patients (aged >15 years) who fulfilled the criteria for sepsis or septic shock, with a documented surgical source of infection, and who were HIV positive were reviewed. RESULTS During the 5-year study period, a total of 675 patients with a documented surgical source of sepsis were managed by our service; 142 (21%) of these were HIV positive. Among the individuals who were HIV positive, the CD4 count was <200 cells/µl in 21 patients and ≥200 cells/µl in 121 patients. There was no difference between these two cohorts in terms of demography or spectrum of surgical conditions. The range of surgical procedures and complications was also similar in both groups. Nevertheless, patients with a CD count of <200 cells/µl had a significantly longer length of hospital stay than those in the cohort with ≥200 cells/µl. For HIV positive patients with a CD4 count of <200 cells/µl, the mortality rate was 66.7% (14/21) while the mortality rate for individuals with HIV and a CD4 count of ≥200 cells/µl was 2.5% (2/121). This difference was statistically significant (p<0.001). CONCLUSIONS The clinical presentation and spectrum of surgical sepsis disease in cases with stage 1 and stage 2 HIV is not markedly different. However, in patients with a CD4 count of <200 cells/µl, the length of hospital stay and mortality is significantly higher. Stage of HIV disease must be considered when stratifying patients' risk for surgery.

Prevalence and Risk Factors of Mortality among Adult HIV Patients Initiating ART in Rural Setting of HIV Care and Treatment Services in North Western Tanzania: A Retrospective Cohort Study

Introduction

HIV still causes high mortality despite use of ART. This study was designed to determine the prevalence and risk factors of mortality among HIV patients receiving ART in northwestern rural Tanzania.

Methods

A retrospective study of HIV patients on ART was done at Sengerema in Mwanza, Tanzania. The data on demography, date of HIV diagnosis, WHO stage, opportunistic infections, CD4, hemoglobin, ART regimen, and time and outcome on treatment as dead or alive were collected and analyzed using STATA version 11.

Results

In total, 740 patients were studied. The median age was 35 (27–42) years with female predominance of 465 (62.8%). Of the participants, 261 (35.3%) had WHO stages 3 and 4 diseases. Most participants, 258 (34.9%), had baseline CD4 counts <200 cells/μl. Deaths occurred in 86 (11.6%) patients which were independently associated with male gender (16.0% versus 9.0%, p = 0.015), being divorced (OR = 2.7, p < 0.001), WHO stages 3 and 4 (OR = 2.3, p = 0.05), CD4 <200 cells/μl (OR = 3.4, p < 0.001), and severe anemia (OR = 6.6, p < 0.001).

Conclusions

The mortality is high among HIV patients receiving ART in northwestern rural Tanzania. Universal testing could increase early diagnosis and treatment. A close follow-up of at-risk patients within the first year of ART could reduce the mortality of this subgroup of patients.

Mortality-trend observation in HIV/AIDS patients under antiretroviral therapy at a referral hospital in Beijing, China

Aim: To study the mortality trends of HIV-1-infected patients from 2005 to 2014; to compare the mortality rate between the periods 2005 and 2010 and 2011 and 2014; and to understand the effect on mortality of initiating combination antiretroviral therapy (cART) at different baseline CD4 cell counts. Methods: This retrospective cohort study evaluated mortality among HIV-1-infected adults initiating cART during 2005–2010 and 2011–2014 at Beijing Ditan Hospital, China. Result: Data from 3057 patients were studied. During 2005–2010 and 2011–2014, median baseline CD4 cell counts were 143 and 245 cells/μl, respectively, and mortality rates were 3.7 and 2.1%, respectively. These differences were significant. Conclusion: The reduction in mortality during 2005–2010 and 2011–2014 was driven by higher baseline CD4 cell counts at cART initiation.