Kibreab Fitsum, Russom Mulugeta, Berhane Araia, Araia Minassie Mengisteab, Bamidele Moyosola A, Cleenewerck de Kiev Laurent
Health Research and Resources Centre Division, Ministry of Health, Asmara, Eritrea.
Eritrean Pharmacovigilance Centre, National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea.
Infect Drug Resist. 2025 Aug 18;18:4165-4178. doi: 10.2147/IDR.S517582. eCollection 2025.
HIV/AIDS continues to be a significant public health concern globally, particularly in low- and middle-income countries. In Eritrea, despite access to antiretroviral therapy (ART), many people living with HIV (PLHIV) continue to experience early mortality. Furthermore, survival analysis among those patients has not been conducted. Thus, this study aimed to assess the survival rates and identify the determinants of PLHIV on ART in two national referral hospitals in Eritrea.
A retrospective cohort study was used to recruit PLHIV aged 15 years or above who started ART between August 2005 and December 31, 2020, in Halibet National Referral Hospital (HNRH) and Orotta National Referral and Teaching Hospital. Data were extracted from a database and patients' medical records (patients' medical cards, laboratory results, and registries). The Kaplan-Meier estimator and the extended Cox proportional hazards regression were used for analysis.
Of 3646 study participants, 11.5% died, 55.7% were on follow-up, 14.2% transferred out, and 18.5% lost to follow-up. The mortality rate was 1.32 per 100 person-years (95% CI: 1.20-1.44). Furthermore, by the end of the follow-up period, 79.7% of the patients survived. Of those who died, 70% and 60% survived their first and second year of ART initiation, respectively. Age above 45 years (HR=1.58, 95% CI: 1.05-2.37), ambulatory functional status (HR=2.49, 95% CI: 1.79-3.47), bedridden functional status (HR=2.88, 95% CI: 1.77-4.69), poor adherence (HR=1.57, 95% CI: 1.09-2.28), fair adherence (HR=2.19, 95% CI: 1.66-2.89) were predictors of poor survival. Conversely, CD4 count (cell/mm) 101-200 (HR=0.38, 95% CI: 0.25-0.55), 201-350 (HR=0.18, 95% CI: 0.11-0.27), above 350 (HR=0.05, 95% CI: 0.02-0.07), body weight 45-60 kg (HR=0.75, 95% CI: 0.59-0.94), weight above 60 kg (HR=0.53, 95% CI: 0.39-0.72), widowed (HR=0.49, 95% CI: 0.36-0.67), and residing outside Zoba Maekel (HR=0.53, 95% CI: 0.34-0.82) were predictors of good survival.
The mortality rate is relatively low. PLHIV who started ART above 45 years, bedridden and ambulatory, and those with poor adherence were more likely to have lower survival. HIV/AIDS control programs and other stakeholders are strongly recommended to strengthen community awareness of the importance of early testing, immediate initiation of ART, regular follow-up and treatment adherence.
艾滋病毒/艾滋病仍然是全球重大的公共卫生问题，在低收入和中等收入国家尤为如此。在厄立特里亚，尽管可获得抗逆转录病毒疗法（ART），但许多艾滋病毒感染者（PLHIV）仍过早死亡。此外，尚未对这些患者进行生存分析。因此，本研究旨在评估厄立特里亚两家国家转诊医院中接受抗逆转录病毒治疗的艾滋病毒感染者的生存率，并确定其生存的决定因素。
采用回顾性队列研究，招募2005年8月至2020年12月31日期间在哈利贝特国家转诊医院（HNRH）和奥罗塔国家转诊和教学医院开始接受抗逆转录病毒治疗的15岁及以上的艾滋病毒感染者。数据从数据库和患者病历（患者医疗卡、实验室结果和登记册）中提取。使用Kaplan-Meier估计器和扩展的Cox比例风险回归进行分析。
在3646名研究参与者中，11.5%死亡，55.7%在随访中，14.2%转出，18.5%失访。死亡率为每100人年1.32例（95%CI：1.20-1.44）。此外，到随访期结束时，79.7%的患者存活。在死亡的患者中，分别有70%和60%在开始抗逆转录病毒治疗的第一年和第二年存活。45岁以上（HR=1.58，95%CI：1.05-2.37）、非卧床功能状态（HR=2.49，95%CI：1.79-3.47）、卧床功能状态（HR=2.88，95%CI：1.77-4.69）、依从性差（HR=1.57，95%CI：1.09-2.28）、依从性一般（HR=2.19，95%CI：1.66-2.89）是生存不良的预测因素。相反，CD4细胞计数（个/立方毫米）101-200（HR=0.38，95%CI：0.25-0.55）、201-350（HR=0.18，95%CI：0.11-0.27）、高于350（HR=0.05，95%CI：0.02-0.07）、体重45-60千克（HR=0.75，95%CI：0.59-0.94）、体重高于60千克（HR=0.53，95%CI：0.39-0.72）、丧偶（HR=0.49，95%CI：0.36-0.67）以及居住在马萨瓦省以外（HR=0.53，95%CI：0.34-0.82）是生存良好的预测因素。
死亡率相对较低。45岁以上开始接受抗逆转录病毒治疗、卧床和非卧床以及依从性差的艾滋病毒感染者生存可能性较低。强烈建议艾滋病毒/艾滋病控制项目和其他利益相关者加强社区对早期检测、立即开始抗逆转录病毒治疗、定期随访和治疗依从性重要性的认识。
