Department of Nursing, College of Medicine & Health Sciences, Jigjiga University, Jijiga, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Infect Dis. 2024 Nov 27;24(1):1352. doi: 10.1186/s12879-024-10225-2.
Human Immune Deficiency Virus (HIV) remains the leading cause of morbidity and mortality globally. It can lead to Acquired Immunodeficiency Syndrome (AIDS), which results in gradual deterioration and failure of the immune system. As the immune system becomes compromised, the patient becomes highly susceptible to life-threatening infection which ends with early death. Even though Antiretroviral Therapy (ART) significantly decreases mortality as a whole, the rate of death is still the highest, especially in the first and second years of ART initiation. The study aims to assess the survival and predictors of mortality among HIV-infected adults after initiation of antiretroviral therapy in Jigjiga City Governmental Hospitals, Eastern Ethiopia.
Institution-based Retrospective follow-up study was employed among ART patients from January 1, 2015, to December 31, 2021. Data were cleaned and entered in Epi-data version 3.1 and exported to STATA 14 for further analysis. Kaplan-Meier and Log-Rank tests were applied to compare survival differences among categories of different variables. In bi-variable analysis, P-values < 0.20 were included in a multivariable analysis. A multivariable Cox regression model was used to measure the risk of death identify the and significant predictors of death. Variables that a P-value < 0.05 were considered statistically significant predictors of mortality.
In this study 466(53.34%) participants were male and 552(65.56%) were urban residents about 91(10.81%) have died with an overall incidence rate of 3.92 (95% CI (2.43-5.41)) per 100-person year of observation. The overall survival probability of the study group was 83.97%. In the multivariable Cox regression analysis, baseline World Health Organization (WHO) stage III/IV (AHR = 2.42(1.43-4.09)) have no caregiver (AHR = 2.23; 95% CI (1.16-4.29)), being bedridden functional status (AHR = 2.18; 95% CI (1.01-4.72)), and poor last known adherence level (AHR = 4.23; 95%CI (2.39-7.47)) were found to be significant predictors of mortality.
The incidence of death was relatively high, especially in the second year of ART. Baseline clinical WHO stage III/IV, bedridden functional status at enrolment, and absence of caregiver, poor level of recent adherence were found to be independent predictors of mortality. Patients with these risk factors need special attention and are crucial to reducing the rate of mortality.
人类免疫缺陷病毒（HIV）仍然是全球发病率和死亡率的主要原因。它会导致获得性免疫缺陷综合征（AIDS），从而导致免疫系统逐渐恶化和衰竭。随着免疫系统受到损害，患者极易受到危及生命的感染，最终导致早逝。尽管抗逆转录病毒疗法（ART）总体上显著降低了死亡率，但死亡率仍然最高，尤其是在开始接受 ART 的第一和第二年。本研究旨在评估在埃塞俄比亚东部吉吉加市政府医院接受抗逆转录病毒治疗的 HIV 感染成年人的生存和死亡预测因素。
采用 2015 年 1 月 1 日至 2021 年 12 月 31 日期间在接受 ART 的患者中进行基于机构的回顾性随访研究。数据在 Epi-data 版本 3.1 中进行清理和输入，并导出到 STATA 14 进行进一步分析。Kaplan-Meier 和 Log-Rank 检验用于比较不同类别之间的生存差异。在双变量分析中，将 P 值<0.20 的变量纳入多变量分析。使用多变量 Cox 回归模型来衡量死亡风险并确定死亡的显著预测因素。P 值<0.05 的变量被认为是死亡率的统计学显著预测因素。
本研究中，466 名（53.34%）参与者为男性，552 名（65.56%）为城市居民，其中 91 名（10.81%）死亡，总死亡率为 3.92（95%CI（2.43-5.41））每 100 人年观察到的发病率。研究组的总体生存率为 83.97%。在多变量 Cox 回归分析中，基线世界卫生组织（WHO）分期 III/IV（AHR=2.42（1.43-4.09））无照顾者（AHR=2.23；95%CI（1.16-4.29））、卧床不起的功能状态（AHR=2.18；95%CI（1.01-4.72））和最近的依从性水平差（AHR=4.23；95%CI（2.39-7.47））被发现是死亡率的显著预测因素。
死亡率相对较高，尤其是在接受 ART 的第二年。基线临床 WHO 分期 III/IV、入组时卧床不起的功能状态以及无照顾者、近期依从性差是死亡的独立预测因素。具有这些危险因素的患者需要特别关注，这对于降低死亡率至关重要。
