Incidence and determinants of mortality among adult HIV infected patients on second-line antiretroviral treatment in Amhara region, Ethiopia: a retrospective follow up study

Abstract

Introduction: mortality of adult patients who are on antiretroviral therapy (ART) is higher in low-income than in high-income countries. After the
failure of standard first-line treatment, patients switch to second-line regimens. However, there are limited data about the outcome of patients after
switching to a second-line regimen in the study area. This study aimed to measure the rate of mortality and its determinants among HIV patients on
second-line ART regimens. Methods: multicenter institution based retrospective follow up study was conducted among 1192 adult patients who
started second-line ART between 2008 and 2016 in eight selected hospitals of Amhara region. Patients who started second-line treatment after the
failure of first-line treatment were included. Patient medical records, registration books, and computer database were used to collect the data. Time
to death after a switch to second-line ART was the primary outcome of interest. Cox proportional hazard model was fitted to identify determinant
factors of mortality. Results: among 1192 patients who were on second-line ART, 136 (11.4%) died with 3,157 person-years of follow up. Over the
study period, the mortality rate was 4.33 per 100 person-years. Not taking isoniazid preventive therapy (IPT)
(Adjusted Hazard Ratio (AHR): 6.6; 95% CI: 2.9, 15.0), did not make modification on second-line regimen (AHR: 4.4; 95% CI: 2.8, 6.8), poor clinical
adherence (AHR: 2.5; 95% CI: 1.4, 4.5), functional status of bedridden (AHR: 2.7; 95% CI: 1.5, 4.8), and having attained a tertiary level of education
(AHR: 0.4; 95% CI: 0.2, 0.8) were independent determinants of mortality. Conclusion: the incidence rate of mortality was high and most of the
deaths occurred within 12 months after switching to second-line ART. Higher mortality among adult HIV-infected patients was associated with poor
adherence, no formal education, not taking IPT, being bedridden at the time of the switch, and not modifying second-line treatment. Improving
treatment adherence of patients by providing consistent adherence counseling, providing INH prophylaxis and monitoring patient's regimen more
closely during the first twelve months after switch could decrease mortality of HIV patients on a second-line regimen.