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Risk factors for mortality among adult HIV/AIDS patients following antiretroviral therapy in Southwestern Ethiopia : an assessment through survival models

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Abstract
Introduction: Efforts have been made to reduce HIV/AIDS-related mortality by delivering antiretroviral therapy (ART) treatment. However, HIV patients in resource-poor settings are still dying, even if they are on ART treatment. This study aimed to explore the factors associated with HIV/AIDS-related mortality in Southwestern Ethiopia. Method: A non-concurrent retrospective cohort study which collected data from the clinical records of adult HIV/AIDS patients, who initiated ART treatment and were followed between January 2006 and December 2010, was conducted, to explore the factors associated with HIV/AIDS-related mortality at Jimma University Specialized Hospital (JUSH). Survival times (i. e., the time from the onset of ART treatment to the death or censoring) and different characteristics of patients were retrospectively examined. A best-fit model was chosen for the survival data, after the comparison between native semi-parametric Cox regression and parametric survival models (i. e., exponential, Weibull, and log-logistic). Result: A total of 456 HIV patients were included in the study, mostly females (312, 68.4%), with a median age of 30 years (inter-quartile range (IQR): 23-37 years). Estimated follow-up until December 2010 accounted for 1245 person-years at risk (PYAR) and resulted in 66 (14.5%) deaths and 390 censored individuals, representing a median survival time of 34.0 months (IQR: 22.8-42.0 months). The overall mortality rate was 5.3/100 PYAR: 6.5/100 PYAR for males and 4.8/100 PYAR for females. The Weibull survival model was the best model for fitting the data (lowest AIC). The main factors associated with mortality were: baseline age (> 35 years old, AHR = 3.8, 95% CI: 1.6-9.1), baseline weight (AHR = 0.93, 95% CI: 0.90-0.97), baseline WHO stage IV (AHR = 6.2, 95% CI: 2.2-14.2), and low adherence to ART treatment AHR = 4.2, 95% CI: 2.5-7.1). Conclusion: An effective reduction in HIV/AIDS mortality could be achieved through timely ART treatment onset and maintaining high levels of treatment adherence.
Keywords
antiretroviral therapy (ART), HIV/AIDS, parametric survival model, Ethiopia, HIV-INFECTED PATIENTS, ADDIS-ABABA, AIDS, DEATH

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Chicago
Seyoum, Dinberu, Jean-Marie Degryse, Yehenew Getachew Kifle, Ayele Taye, Mulualem Tadesse, Belay Birlie, Akalu Banbeta, Angel Rosas-Aguirre, Luc Duchateau, and Niko Speybroeck. 2017. “Risk Factors for Mortality Among Adult HIV/AIDS Patients Following Antiretroviral Therapy in Southwestern Ethiopia : an Assessment Through Survival Models.” International Journal of Environmental Research and Public Health 14 (3).
APA
Seyoum, D., Degryse, J.-M., Kifle, Y. G., Taye, A., Tadesse, M., Birlie, B., Banbeta, A., et al. (2017). Risk factors for mortality among adult HIV/AIDS patients following antiretroviral therapy in Southwestern Ethiopia : an assessment through survival models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 14(3).
Vancouver
1.
Seyoum D, Degryse J-M, Kifle YG, Taye A, Tadesse M, Birlie B, et al. Risk factors for mortality among adult HIV/AIDS patients following antiretroviral therapy in Southwestern Ethiopia : an assessment through survival models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH. 2017;14(3).
MLA
Seyoum, Dinberu, Jean-Marie Degryse, Yehenew Getachew Kifle, et al. “Risk Factors for Mortality Among Adult HIV/AIDS Patients Following Antiretroviral Therapy in Southwestern Ethiopia : an Assessment Through Survival Models.” INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 14.3 (2017): n. pag. Print.
@article{8535122,
  abstract     = {Introduction: Efforts have been made to reduce HIV/AIDS-related mortality by delivering antiretroviral therapy (ART) treatment. However, HIV patients in resource-poor settings are still dying, even if they are on ART treatment. This study aimed to explore the factors associated with HIV/AIDS-related mortality in Southwestern Ethiopia.
Method: A non-concurrent retrospective cohort study which collected data from the clinical records of adult HIV/AIDS patients, who initiated ART treatment and were followed between January 2006 and December 2010, was conducted, to explore the factors associated with HIV/AIDS-related mortality at Jimma University Specialized Hospital (JUSH). Survival times (i. e., the time from the onset of ART treatment to the death or censoring) and different characteristics of patients were retrospectively examined. A best-fit model was chosen for the survival data, after the comparison between native semi-parametric Cox regression and parametric survival models (i. e., exponential, Weibull, and log-logistic).
Result: A total of 456 HIV patients were included in the study, mostly females (312, 68.4\%), with a median age of 30 years (inter-quartile range (IQR): 23-37 years). Estimated follow-up until December 2010 accounted for 1245 person-years at risk (PYAR) and resulted in 66 (14.5\%) deaths and 390 censored individuals, representing a median survival time of 34.0 months (IQR: 22.8-42.0 months). The overall mortality rate was 5.3/100 PYAR: 6.5/100 PYAR for males and 4.8/100 PYAR for females. The Weibull survival model was the best model for fitting the data (lowest AIC). The main factors associated with mortality were: baseline age ({\textrangle} 35 years old, AHR = 3.8, 95\% CI: 1.6-9.1), baseline weight (AHR = 0.93, 95\% CI: 0.90-0.97), baseline WHO stage IV (AHR = 6.2, 95\% CI: 2.2-14.2), and low adherence to ART treatment AHR = 4.2, 95\% CI: 2.5-7.1).
Conclusion: An effective reduction in HIV/AIDS mortality could be achieved through timely ART treatment onset and maintaining high levels of treatment adherence.},
  articleno    = {296},
  author       = {Seyoum, Dinberu and Degryse, Jean-Marie and Kifle, Yehenew Getachew and Taye, Ayele and Tadesse, Mulualem and Birlie, Belay and Banbeta, Akalu and Rosas-Aguirre, Angel and Duchateau, Luc and Speybroeck, Niko},
  issn         = {1660-4601},
  journal      = {INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH},
  keyword      = {antiretroviral therapy (ART),HIV/AIDS,parametric survival model,Ethiopia,HIV-INFECTED PATIENTS,ADDIS-ABABA,AIDS,DEATH},
  language     = {eng},
  number       = {3},
  pages        = {12},
  title        = {Risk factors for mortality among adult HIV/AIDS patients following antiretroviral therapy in Southwestern Ethiopia : an assessment through survival models},
  url          = {http://dx.doi.org/10.3390/ijerph14030296},
  volume       = {14},
  year         = {2017},
}

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