Bwogi Kabali, Lwanira Catherine Nassozi, Kasamba Ivan, Baluku Joseph Baruch, Nakiwala Justine K, Ndagire Regina, Nassolo Catherine, Wabomba Gerald, Bwanika Christopher, Nakawesi Jane, Namayanja Grace, Kabanda Joseph, Kalamya Julius N, Ssempiira Julius, Ssenyimba Catherine, Mulebeke Ronald, Fitzmaurice Arthur G, Mukasa Barbara
Mildmay Uganda, 12 Km Entebbe Road, Naziba Hill, Lweza, P. O. Box 24985, Kampala, Uganda.
Department of Research, School of Graduate Studies, Research and Innovations, Clarke International University, PO Box 7782, Kampala, Uganda.
BMC Infect Dis. 2025 Aug 2;25(1):976. doi: 10.1186/s12879-025-11397-1.
Despite global efforts to improve HIV care, late diagnosis and delayed antiretroviral therapy (ART) initiation continue to pose mortality risks among people living with HIV (PLHIV) with advanced HIV disease (AHD). This study investigated factors associated with mortality among PLHIV with AHD in rural North-Central Uganda from January 2018 to December 2021.
We retrospectively reviewed electronic medical records from 18 health facilities, collecting data on demographics and clinical characteristics, including baseline CD4 count, ART regimen, BMI, TB status, TPT use, WHO clinical stage, and viral load. AHD was defined as a baseline CD4 < 200 cells/mm³. Cox proportional hazards modeling identified mortality-associated factors, reported as adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), using a 5% significance level.
We analyzed 1161 PLHIV with AHD, contributing 1565.6 person-years. There were 84 deaths (7.2%), yielding a mortality rate of 5.4 per 100 person-years (95% CI: 4.33-6.64). Mortality was significantly associated with age ≥ 50 years (aHR 4.16 [1.77-9.77]), no viral load test (aHR 16.23 [7.44-35.39]), viral load non-suppression (aHR 9.05 [3.37-24.29]), CD4 ≤ 50 (aHR 1.91 [1.08-3.39]), no TB prophylaxis (aHR 3.51 [1.83-6.74]), and WHO stage 3 or 4 (aHR 1.91 [1.12-3.27]).
Despite advances in HIV programs, the mortality rate among patients with AHD highlights ongoing challenges. Early identification of AHD patients, regular viral load testing, optimizing ART and ensuring adherence, along with promoting tuberculosis preventive therapy, could help reduce mortality, improve patient outcomes, and achieve HIV epidemic control by 2030.
尽管全球致力于改善艾滋病病毒（HIV）护理，但晚期诊断和延迟开始抗逆转录病毒治疗（ART）仍然给患有晚期HIV疾病（AHD）的HIV感染者（PLHIV）带来死亡风险。本研究调查了2018年1月至2021年12月乌干达中北部农村地区患有AHD的PLHIV的死亡相关因素。
我们回顾性审查了18家医疗机构的电子病历，收集了人口统计学和临床特征数据，包括基线CD4细胞计数、ART方案、体重指数（BMI）、结核病状态、预防性抗结核治疗（TPT）使用情况、世界卫生组织（WHO）临床分期和病毒载量。AHD定义为基线CD4＜200个细胞/mm³。Cox比例风险模型确定了死亡相关因素，报告为调整后的风险比（aHR）及95%置信区间（CI），显著性水平为5%。
我们分析了1161例患有AHD的PLHIV，共1565.6人年。有84例死亡（7.2%），死亡率为每100人年死亡5.4例（95%CI：4.33 - 6.64）。死亡率与年龄≥50岁（aHR 4.16[1.77 - 9.77]）、未进行病毒载量检测（aHR 16.23[7.44 - 35.39]）、病毒载量未被抑制（aHR 9.05[3.37 - 24.29]）、CD4≤50（aHR 1.91[1.08 - 3.39]）、未进行结核病预防（aHR 3.51[1.83 - 6.74]）以及WHO 3期或4期（aHR 1.91[1.12 - 3.27]）显著相关。
尽管HIV项目取得了进展，但AHD患者的死亡率凸显了持续存在的挑战。早期识别AHD患者、定期进行病毒载量检测、优化ART并确保依从性，以及推广结核病预防性治疗，有助于降低死亡率、改善患者预后，并在2030年前实现HIV流行的控制。
