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Determinants of survival in adult HIV patients on antiretroviral therapy in Oromiyaa, Ethiopia.

Alemu AW, Sebastián MS - Glob Health Action (2010)

Bottom Line: In multivariate analysis, 2-year survival was significantly associated with the clinical stage of the disease, baseline hemoglobin, and cotrimoxazole prophylaxis therapy (CPT) at or before ART initiation in both assumptions.The median CD4 count and body weight showed a marked improvement during the first 6 months of treatment, followed by stagnation thereafter.The utilization of routine data should be encouraged in order to facilitate appropriate decision making.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology and Public Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden.

ABSTRACT

Background: The antiretroviral treatment (ART) scale-up service has been a recent development in Ethiopia, but its impact on mortality has not been well investigated. The aim of this study was to assess the early survival outcome of the scale-up service by utilizing routine hospital data.

Methods: All adult HIV/AIDS patients who started on antiretroviral treatment in Shashemene and Assela hospitals from January 1, 2006 to May 31, 2006 were included and followed up for 2 years. Data were extracted from standard patient medical registrations. Kaplan-Meier curves were used to estimate survival probability and the Cox proportional hazard model was applied to determine predictors of mortality. Two alterative assumptions (real case and worst case) were made in determining predictors of mortality.

Results: The median age of patients was 33 years and 57% were female. Eighty-five percent had CD4 <200 cells/µL with a median CD4 count of 103 cells/µL. The median survival time was 104.4 weeks. A total of 28 (10.3%) deaths were observed during the 2-year period and 48 patients (18%) were lost to follow up. The majority of deaths occurred in the first 4 months of treatment. In multivariate analysis, 2-year survival was significantly associated with the clinical stage of the disease, baseline hemoglobin, and cotrimoxazole prophylaxis therapy (CPT) at or before ART initiation in both assumptions. The median CD4 count and body weight showed a marked improvement during the first 6 months of treatment, followed by stagnation thereafter.

Conclusion: The study has shown an overall low mortality but a high loss to follow-up rate of the cohort. Advanced clinical stage, anemia, low body weight, and lack of CPT initiation were independent predictors of mortality - but not gender. CPT initiation should be encouraged in routine HIV care services, and patient retention mechanisms have to be strengthened. Stagnation in immunological and weight recovery after the first 6 months should be further investigated. The utilization of routine data should be encouraged in order to facilitate appropriate decision making.

No MeSH data available.


Related in: MedlinePlus

Inclusion of the study cohort for analysis.
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Figure 0001: Inclusion of the study cohort for analysis.

Mentions: A total of 290 patients were initiated with ART in both facilities during the study period. Data available for analysis included 272 ART patients (Fig. 1). The cohort contributed to a total of 409.9 person-years of follow up. The mean duration of follow up was 104.4 weeks.


Determinants of survival in adult HIV patients on antiretroviral therapy in Oromiyaa, Ethiopia.

Alemu AW, Sebastián MS - Glob Health Action (2010)

Inclusion of the study cohort for analysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2967337&req=5

Figure 0001: Inclusion of the study cohort for analysis.
Mentions: A total of 290 patients were initiated with ART in both facilities during the study period. Data available for analysis included 272 ART patients (Fig. 1). The cohort contributed to a total of 409.9 person-years of follow up. The mean duration of follow up was 104.4 weeks.

Bottom Line: In multivariate analysis, 2-year survival was significantly associated with the clinical stage of the disease, baseline hemoglobin, and cotrimoxazole prophylaxis therapy (CPT) at or before ART initiation in both assumptions.The median CD4 count and body weight showed a marked improvement during the first 6 months of treatment, followed by stagnation thereafter.The utilization of routine data should be encouraged in order to facilitate appropriate decision making.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology and Public Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden.

ABSTRACT

Background: The antiretroviral treatment (ART) scale-up service has been a recent development in Ethiopia, but its impact on mortality has not been well investigated. The aim of this study was to assess the early survival outcome of the scale-up service by utilizing routine hospital data.

Methods: All adult HIV/AIDS patients who started on antiretroviral treatment in Shashemene and Assela hospitals from January 1, 2006 to May 31, 2006 were included and followed up for 2 years. Data were extracted from standard patient medical registrations. Kaplan-Meier curves were used to estimate survival probability and the Cox proportional hazard model was applied to determine predictors of mortality. Two alterative assumptions (real case and worst case) were made in determining predictors of mortality.

Results: The median age of patients was 33 years and 57% were female. Eighty-five percent had CD4 <200 cells/µL with a median CD4 count of 103 cells/µL. The median survival time was 104.4 weeks. A total of 28 (10.3%) deaths were observed during the 2-year period and 48 patients (18%) were lost to follow up. The majority of deaths occurred in the first 4 months of treatment. In multivariate analysis, 2-year survival was significantly associated with the clinical stage of the disease, baseline hemoglobin, and cotrimoxazole prophylaxis therapy (CPT) at or before ART initiation in both assumptions. The median CD4 count and body weight showed a marked improvement during the first 6 months of treatment, followed by stagnation thereafter.

Conclusion: The study has shown an overall low mortality but a high loss to follow-up rate of the cohort. Advanced clinical stage, anemia, low body weight, and lack of CPT initiation were independent predictors of mortality - but not gender. CPT initiation should be encouraged in routine HIV care services, and patient retention mechanisms have to be strengthened. Stagnation in immunological and weight recovery after the first 6 months should be further investigated. The utilization of routine data should be encouraged in order to facilitate appropriate decision making.

No MeSH data available.


Related in: MedlinePlus