Survival and Predictors of the Survival of HIV-Infected Adult Patients Taking HAART at Hawassa University Referral Hospital

Abstract

Introduction: The discovery of the combined antiretroviral therapy was a turning point which changed the outlook about AIDS from a virtually death sentence to a manageable chronic disease. Although the field of HIV medicine is rapidly changing, there is lack of recent knowledge about the survival and the predictors of the survival of HIV-infected patients taking HAART in the study area. 

Objective: To assess the predictors of the survival of patients living with HIV/AIDS who are taking highly active antiretroviral therapy.

Methods: Retrospective three-year follow up (cohort) study was employed for randomly selected 436 HIV infected adult patients who were HAART initiated at Hawassa University Referral Hospital. Data was collected from the patients’ records by trained BSc. nurses who used a pretested and structured checklist. The Kaplan-Meier and the Cox proportional hazards model were used to estimate survival after HAART initiation and to identify predictors, respectively. Descriptive summary statistics, bivariate, and multivariate regression analyses were used for significance tests.

Result: Two hundred fifty-seven (58.9%) study subjects were females and the median age of patients was 31years (IQR=27-39). Three hundred and twelve (71.5%) of the subjects were below 10^th grade in educational status with 199 (45.6%) ambulatory and bedridden in functional status, 413 (94.7%) in stages III & IV at the initiation of ART. Two hundred eighty-five (65.4%) of the patients had a CD₄ cell count of less than 200cells/µl, and there were a total of 52 deaths during the follow up period of which 32 (61.5%) & 42 (80.8%) died within the first three and six months of initiation of therapy, respectively. The cumulative probabilities of survival of these patients were 90%, 88%, 87.5% and 87% at 6, 12, 24 and 36 months, respectively. Male sex (HR=1.961, P-value=0.038), bedridden (HR=6.023, P-value<0.001) functional status, CD₄ count below 50cells/µl (HR=3.388, P-value=0.012), not using Cotrimoxazole chemoprophylaxis (HR=2.883, P-value= 0.018) and hemoglobin level below 10mg/dl (HR=6.393, P-value<0.001) were statistically significant predictors of survival, indicating that being male, bedridden, CD₄ count of less than 50cells/µl, not using chemoprophylaxis, and hemoglobin level <10mg/dl  increase the risk of death of HIV infected patients who are taking ART with respective hazard ratios.

Conclusion: Delayed initiation of ART and not using chemoprophylaxis are poor prognostic factors of survival for HIV/AIDS patients.