Predictors of All-Cause Mortality Among People With Human Immunodeficiency Virus (HIV) in a Prospective Cohort Study in East Africa and Nigeria.
Clin Infect Dis
; 75(4): 657-664, 2022 09 10.
Article
em En
| MEDLINE
| ID: mdl-34864933
ABSTRACT
BACKGROUND:
Introduction of antiretroviral therapy (ART) has been associated with a decline in human immunodeficiency virus (HIV)-related mortality, although HIV remains a leading cause of death in sub-Saharan Africa. We describe all-cause mortality and its predictors in people living with HIV (PLWH) in the African Cohort Study (AFRICOS).METHODS:
AFRICOS enrolls participants with or without HIV at 12 sites in Kenya, Uganda, Tanzania, and Nigeria. Evaluations every 6 months include sociobehavioral questionnaires, medical history, physical examination, and laboratory tests. Mortality data are collected from medical records and survivor interviews. Multivariable Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for factors associated with mortality.RESULTS:
From 2013 through 2020, 2724 PLWH completed at least 1 follow-up visit or experienced death. Of these 58.4% were females, 25.8% were agedâ ≥â 50 years, and 98.3% were ART-experienced. We observed 11.42 deaths per 1000 person-years (95% CI 9.53-13.68) with causes ascertained in 54% of participants. Deaths were caused by malignancy (28.1%), infections (29.7%), and other non-HIV related conditions. Predictors of mortality included CD4â ≤â 350 cells/µL (aHR 2.01 [95% CI 1.31-3.08]), a log10copies/mL increase of viral load (aHR 1.36 [95% CI 1.22-1.51]), recent fever (aHR 1.85[95% CI 1.22-2.81]), body mass indexâ <â 18.5 kg/m2 (aHR 2.20 [95% CI 1.44-3.38]), clinical depression (aHR 2.42 [95% CI 1.40-4.18]), World Health Organization (WHO) stage III (aHR 2.18 [95% CI 1.31-3.61]), a g/dL increase in hemoglobin (aHR 0.79 [95% CI .72-.85]), and every year on ART (aHR 0.67 [95% CI .56-.81]).CONCLUSIONS:
The mortality rate was low in this cohort of mostly virally suppressed PLWH. Patterns of deaths and identified predictors suggest multiple targets for interventions to reduce mortality.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Fármacos Anti-HIV
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
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Humans
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Male
País como assunto:
Africa
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article