Assesment of Predictors of Survival in Patients Living with HIV/AIDS after the Advent of Highly Active Antiretroviral Therapy in Addis Ababa Ethiopia

Bedru, Abdo (2009) Assesment of Predictors of Survival in Patients Living with HIV/AIDS after the Advent of Highly Active Antiretroviral Therapy in Addis Ababa Ethiopia. Masters thesis, Addis Ababa University.

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Abstract

BACKGROUND: The introduction of highly active antiretroviral therapy in 1996 dramatically improved survival and quality of HIV-infected patients in the industrialized world. This survival benefit of HAART in HIV infection has been well studied in the developed world. In resource-poor settings, where such treatment was started only recently, limited data exist on treatment results. More over mortality have been high particularly in the first month of initiating ART and factors contributing to this high mortality are poorly understood. OBJECTIVE: To asses predictors of survival in PLWHA after the advent of HAART. METHODS: A historical cohort study was conducted in Zewditu Hospital located in Addis Ababa, Ethiopia. Patient’s records enrolled between March, 2005 to July, 2008 were reviewed consecutively using patients ART unique identification number as a reference. Different documents for the same patient were triangulated in case of odd values, non logical or missed data. Deaths from all AIDS related cause occurring during the follow-up period were identified from physician reports or registration by drug adherence counselor. Univariate analysis was used to describe patient’s baseline characteristics. Actuarial table was used to estimate survival after intiation of ART, and log rank test was used to compare survival curves. Cox proportional-hazard regression was used to calculate the bivariate and adjusted hazard rate and then determine independent predictors of time to death. RESULT; One thousand seventy patients on ART were followed for a median of 34 month (IQR 6, 36.25). The mean age was 36.4 and the median weight of the cohort at the initiation of ART was 51kg (IQR, 45-60kg).The median CD4 count was 94cells/μl (IQR, 46-154). The estimated mortality was 24.9%, 29%, 31.7%, 33.1%, 33.5, and 34% at 6, 12, 18, 30, and 48 months respectively. After adjustment, the independent significant predictors of not surviving in patients living with HIV/AIDS after initiation of ART remain poor ART adherence (AHR=3.92[95%CI=3.13, 4.90]),Advanced WHO staging (AHR=2.47[95%CI= (1.58, 3.81]), being unemployed (AHR=1.87[95%CI= 1.49, 2.34]), moderate anemia (AHR=1.86[95%CI=1.35, 2.56), and Low CD4 count (AHR=1.85[95%CI= 1.35, 2.52]). CONCLUSION; A careful monitoring of patients with low CD4+ ,advanced WHO staging, moderate anemia and unemployed particularly during the first 3 months of HAART is necessary. Tracing poorly adhered patients and giving them drug counseling is crucial to improve their survival.

Item Type:	Thesis (Masters)
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Africana
Depositing User:	Vincent Mpoza
Date Deposited:	02 Oct 2018 09:34
Last Modified:	02 Oct 2018 09:34
URI:	http://thesisbank.jhia.ac.ke/id/eprint/5740

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