Birhanu Abdi, Dingeta Tariku, Tolera Moti
School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia.
School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia.
HIV AIDS (Auckl). 2021 Jul 2;13:727-736. doi: 10.2147/HIV.S309018. eCollection 2021.
Despite the world has made efforts, the reduction of acquired immunodeficiency syndrome (AIDS) related mortality by giving antiretroviral therapy (ART), still HIV/AIDS is killing people while they are on ART. However, the current progress and associated factors of mortality among ART-taking patients are hardly available. Therefore, this study was aimed to determine predictors of mortality among HIV-infected adult patients after starting antiretroviral therapy in Harar Hospitals, Harari region, Ethiopia.
A facility-based retrospective cohort study was employed with randomly selected 610 medical records of HIV patients on antiretroviral therapy (ART). Adjusted hazard ratio (AHR) with 95% confidence interval (CI) was used to identify predictors of mortality using multivariate Cox proportional hazard model.
Among 610 medical records analyzed with a total of 1410.7 follow-up years, 67 (11%) deaths were found giving an overall mortality rate of 4.75 per 100 person-years. The independent predictor of mortality identified was ambulatory/bedridden functional status (AHR=2.48; 95% CI: 1.43-4.28), taking other than Tenofovir-based regimen (AHR=2.5,95% CI; 1.04-5.94), not taking isoniazid preventive therapy (IPT) (AHR=2.8; 95% CI: 1.61,4.71), hemoglobin <11g/dl (AHR=3.33,95% CI 1.94-5.69), and poor adherence to ART (AHR= 3.62, 95% CI: 1.87-7.0).
This study demonstrated that poor ART adherence, not taking IPT, and initiating ART with a non-Tenofovir-based regimen and low hemoglobin count were significantly associated with the risk of death. For this reason, addressing these all significant predictors is essential to prevent early death.
尽管全球已做出努力，通过提供抗逆转录病毒疗法（ART）降低了获得性免疫缺陷综合征（AIDS）相关死亡率，但仍有HIV/AIDS患者在接受ART治疗期间死亡。然而，目前接受ART治疗患者的死亡率进展及相关因素尚不清楚。因此，本研究旨在确定埃塞俄比亚哈拉里地区哈拉尔医院HIV感染成年患者开始抗逆转录病毒治疗后的死亡预测因素。
采用基于机构的回顾性队列研究，随机选取610份接受抗逆转录病毒治疗（ART）的HIV患者病历。使用多变量Cox比例风险模型，通过调整后的风险比（AHR）及95%置信区间（CI）来确定死亡预测因素。
在分析的610份病历中，随访时间总计1410.7年，发现67例（11%）死亡，总死亡率为每100人年4.75例。确定的死亡独立预测因素为非卧床/卧床功能状态（AHR=2.48；95%CI：1.43-4.28）、采用非替诺福韦方案（AHR=2.5，95%CI；1.04-5.94）、未接受异烟肼预防性治疗（IPT）（AHR=2.8；95%CI：1.61，4.71）、血红蛋白<11g/dl（AHR=3.33，95%CI 1.94-5.69）以及抗逆转录病毒治疗依从性差（AHR=3.62，95%CI：1.87-7.0）。
本研究表明，抗逆转录病毒治疗依从性差、未接受IPT、采用非替诺福韦方案启动ART以及血红蛋白计数低与死亡风险显著相关。因此，解决所有这些重要预测因素对于预防早期死亡至关重要。
