Salih Ahmed Mohammedseid, Yazie Taklo Simeneh, Gulente Tesfaye Molla
Ethiopian Public Health Institute, Afar, Ethiopia.
Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, P.O.Box 272, Debre Tabor, Amhara, Ethiopia.
Heliyon. 2023 Jan 5;9(1):e12840. doi: 10.1016/j.heliyon.2023.e12840. eCollection 2023 Jan.
Although antiretroviral therapy (ART) is well accepted to increase survival of patients with HIV/AIDS, AIDS related deaths continue to be a major problem in sub-Saharan Africa like Ethiopia. Studies have showed variable findings in the survival status of patients with HIV/AIDS initiating ART, and there was no such study in the study area. Therefore, purpose of this study was to determine the survival and predictors of mortality among HIV/AIDS patients starting taking ART in Dubti General Hospital, Afar, Ethiopia.
A 5 year retrospective cohort study was performed among 702 HIV/AIDS patients aged ≥15 years that started ART between December 31, 2010, and December 31, 2015 in Dubti General Hospital, Afar, Ethiopia. A simple random sampling technique was used to select the study subjects from each WHO stage based stratum. Socio-demographic, clinical and survival status data were extracted by reviewing patients' records. Data were analyzed by using SPSS Version 21. Kaplan-Meier and Cox-regression models were used to estimate survival, and explore predictors of mortality. Variables with a p value of <0.05 in multivariate Cox regression analysis were considered statistically significant.
Among 702 study participants, 82 (11.7%) died during follow up, and the overall incidence rate of mortality was 5.81 per 100 person-years. Identified predictors of mortality were being not married (AHR = 3.71, 95% CI: 1.97-6.99), had no formal education (AHR = 2.33, 95% CI: 1.33-4.38), bedridden functional status (AHR = 5.91, 95% CI: 2.71-12.88), advanced WHO stage III and IV (AHR = 4.36, 95% CI: 2.20-8.64), BMI 16-18.4 kg/m (AHR = 3.03, 95% CI: 1.50-6.13), and BMI<16.0 kg/m (AHR = 5.47; 95% CI: 2.85-10.50), CD4 count ≤50 cells/mm (AHR = 6.62, 95% CI: 4.73-8.52), hemoglobin <8 g/dl (AHR = 5.21; 95% CI: 2.64-10.26), not used cotrimoxazole prophylaxis therapy (AHR = 2.78, 95% CI: 1.61-4.73), stavudine based regimen (AHR = 2.34, 95% CI: 1.32-4.13), and zidovudine based regimen (AHR = 2.49, 95% CI: 1.41-4.39).
High mortality was observed in this cohort, and participants with stage III and IV, low CD4 count, low hemoglobin level, bed ridden functional status, low BMI should be closely monitored even with the scarce resources. In addition, the use of cotrimoxazole prophylaxis therapy should be more encouraged to increase survival.
尽管抗逆转录病毒疗法（ART）被广泛认为可提高艾滋病毒/艾滋病患者的生存率，但在撒哈拉以南非洲地区，如埃塞俄比亚，与艾滋病相关的死亡仍然是一个主要问题。研究显示，开始接受抗逆转录病毒治疗的艾滋病毒/艾滋病患者的生存状况存在不同的研究结果，而在该研究地区尚未有此类研究。因此，本研究的目的是确定在埃塞俄比亚阿法尔州杜布提综合医院开始接受抗逆转录病毒治疗的艾滋病毒/艾滋病患者的生存率及死亡预测因素。
对2010年12月31日至2015年12月31日期间在埃塞俄比亚阿法尔州杜布提综合医院开始接受抗逆转录病毒治疗的702名年龄≥15岁的艾滋病毒/艾滋病患者进行了一项为期5年的回顾性队列研究。采用简单随机抽样技术从每个基于世界卫生组织（WHO）分期的阶层中选取研究对象。通过查阅患者记录提取社会人口统计学、临床和生存状况数据。使用SPSS 21版软件进行数据分析。采用Kaplan-Meier法和Cox回归模型估计生存率，并探索死亡预测因素。多变量Cox回归分析中p值<0.05的变量被认为具有统计学意义。
在702名研究参与者中，82人（11.7%）在随访期间死亡，总死亡率为每100人年5.81例。确定的死亡预测因素包括未婚（调整后风险比[AHR]=3.71，95%置信区间[CI]：1.97 - 6.99）、未接受正规教育（AHR = 2.33，95% CI：1.33 - 4.38）、卧床功能状态（AHR = 5.91，95% CI：2.71 - 12.88）、WHO III期和IV期晚期（AHR = 4.36，95% CI：2.20 - 8.64）、体重指数（BMI）为16 - 18.4 kg/m²（AHR = 3.03，95% CI：1.50 - 6.13）以及BMI<16.0 kg/m²（AHR = 5.47；95% CI：2.85 - 10.50）、CD4细胞计数≤50个/mm³（AHR = 6.62，95% CI：4.73 - 8.52）、血红蛋白<8 g/dl（AHR = 5.21；95% CI：2.64 - 10.26）、未使用复方新诺明预防性治疗（AHR = 2.78，95% CI：1.61 - 4.73）、基于司他夫定的治疗方案（AHR = 2.34，95% CI：1.32 - 4.13）以及基于齐多夫定的治疗方案（AHR = 2.49，95% CI：1.41 - 4.39）。
该队列中观察到高死亡率，对于处于III期和IV期、CD4细胞计数低、血红蛋白水平低、卧床功能状态、BMI低的参与者，即使资源稀缺也应密切监测。此外，应更积极鼓励使用复方新诺明预防性治疗以提高生存率。
