Survival analysis of HIV-infected patients under antiretroviral treatment at the Armed Forces General Teaching Hospital, Addis Ababa, Ethiopia

Abstract

Background: The introduction of ART dramatically improved the survival and health quality of HIV-infected patients in the industrialized world; and the survival benefit of ART has been well studied too. However, in resource-poor settings, where such treatment was started only recently, limited data exist on treatment results. Since the military across most countries of the world had been identified as one of the eight vulnerable and most-at-risk sub-populations to HIV/AIDS, it is worthwhile undertaking studies in the area.
Objectives: The objectives of this study were to estimate mortality rate and to identify survival predictors of patients taking ART based on data obtained from Armed Forces Teaching and General Hospital in Addis Ababa, Ethiopia.
Methods: The records of 734 patients enrolled in the Armed Forces General Teaching Hospital in Addis Ababa between September 2003 and August 2007 were reviewed, and a retrospective cohort study conducted. The KaplanMeier method and log-rank test were used to compare the survival experience of different categories of patients. The proportional hazards Cox regression model was employed to identify predictors of mortality.
Results: Of the 734 included in the current study, 86 (11.7%) died during the first 12 months. Of these 28 (32.6%) deaths occurred within the first three months after initiation of ART; another 15 died in the following three months of follow up; that is to say a total of 43 (50%) deaths occurred within six months. In the last six months 43 patients died; that makes the remaining 50% of the total. The most important predictors of mortality at 0.05 level of significance were low CD4 cell count at baseline, employment status, functional status, WHO clinical stages III and IV, TB coinfection, and opportunistic infections.
Conclusion: Based on the finding of the study it can be concluded that a careful monitoring of patients with low CD4 cell count, advanced WHO stages, history of opportunistic infections, ambulatory and bedridden functional status, coinfection with TB and being employed/unemployed must be undertaken in order to improve the survival of AIDS patients.