Predictors of survival among adult Ethiopian patients in the national ART program at Seven University Teaching Hospitals: A prospective cohort study
| Autor: | Daniel Fekade, Yibeltal Assefa, Saro Abdella, Amha Kebede, Nega Baraki, Eyoel Berhan, Teklu Weldegebreal, Alula M. Teklu, Bekele Belayhun, Melake Damen |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male 0301 basic medicine Ethiopia HIV clinical cohort Antiretroviral therapy Survival Pediatrics medicine.medical_specialty Survival Anti-HIV Agents HIV Infections Hospitals University Young Adult 03 medical and health sciences 0302 clinical medicine Risk Factors Interquartile range Antiretroviral Therapy Highly Active Humans Medicine Prospective Studies HIV clinical cohort 030212 general & internal medicine Hospitals Teaching Prospective cohort study Immunodeficiency Proportional Hazards Models business.industry Proportional hazards model Hazard ratio General Medicine Viral Load medicine.disease 030112 virology CD4 Lymphocyte Count Antiretroviral therapy Government Programs Cohort Female Original Article Ethiopia University teaching business Cohort study |
| Zdroj: | Ethiopian Journal of Health Sciences; Vol 27, No 1 (2017): Special Issue; 63-71 Ethiopian Journal of Health Sciences |
| ISSN: | 1029-1857 |
| Popis: | Background: In Ethiopia, the publicly funded antiretroviral treatment (ART) program was started in 2005. Two hundred seventy-five thousand patients were enrolled in the national ART program by 2012. However, there is limited data on mortality and predictors of death among adult patients in the ART program. The study aimed to estimate mortality and risk factors for death among adult, ART-naïve patients, started in the national ART program from January 2009 to July 2013.Methods: Multi-site, prospective, observational cohort study of adult, age > 18 years, ART-naïve patients, started in the national ART program at seven university-affiliated hospitals from January 2009 - July 2013. Kaplan-Meier and Cox regression analyses were used to estimate survival and determine risk factors for death.Results: A total of 976 patients, 594 females (60.9 %), were enrolled into the study. Median age of the cohort was 33years. The median CD4 count at start of ART was 144 cells/μl (interquartile range (IQR) 78-205), and 34.2% (330/965) had CD4 < 100. Sixty-three percent (536/851) had viral load greater than 5 log copies/ml (IQR 4.7-5.7) at base line. One hundred and one deaths were recorded during follow-up period, all-cause mortality rate 10.3%; 5.4 deaths/100 person years of observation, 95% confidence interval 4.4-6.5. Seventy percent of the deaths occurred within six months of starting ART. Cox regression analyses showed that the following measures independently predicted mortality: age >51 years, (Adjusted Hazard Ratio (AHR) 4.01, P=0.003), WHO stages III&IV, (AHR 1.76, p = 0.025), CD4 count, 5 log copies /ml (CHR 1.71, p = 0.037).Conclusion: There is high early on- ART mortality in patients presenting with advanced immunodeficiency. Detecting cases and initiating ART before onset of advanced immunodeficiency might improve survival.Key Words: Ethiopia, HIV clinical cohort, Antiretroviral therapy, Survival |
| Databáze: | OpenAIRE |
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