Survival and Pridictors of Mortality Among Adults on Antiretroviral Therapy in Selected Public Hospitals in Harar, Eastern Ethiopia

There are several predictors of mortality for patients on anti-retroviral treatment (ART): viral load, CD4 count, total lymphocytes, body mass index (BMI) and adherence. However, there is no single proven model for delivering ART. This highlights the urgent need for generating regionally suitable data. The overall objective of this study was to analyze the survival and predictors of mortality in a cohort of adult HIV patients who started ART within three years starting from September 11, 2005 in Harar, Eastern Ethiopia. A retrospective cohort study was conducted among a cohort of 655 people (age > 14 years) living with HIV/AIDS on ART. The data were reviewed for additional two consecutive years. Appropriate survival analysis methods were used.

Among a total 655 adult PLWHA who were naïve to ART, 438 (66.9%) were female and the median age of patients were 33 years. The median follow-up period was 38 months (Inter Quartile Range (IQR) =27-48). During the follow up period, 74 (11.4%) patients were deceased. The cohort was followed for 1913 Person-Years of observation. Total mortality rate over the follow up period was 3.9 per 100 person-years. Most of deaths (n=36, 49%) occurred in the first 3 months of ART initiation. Three baseline factors could be independently identified: World Health Organization clinical stage III and IV (HR =2.134; 95% CI=1.202-3.791); CD4 counts lower than 50cells/µl (HR=2.344; 95% CI=1.404-3.913); not taking base line Cotrimoxazole Prophylaxis Treatment (CPT) (HR=2.463; 95% CI=1.255-4.834).

Despite optimizing ART delivery in Ethiopia, a proportion of early deaths among patients with very advanced disease are not likely to be preventable with ART. This may require extensive and detailed study in resource poor countries. Thus, a more fundamental issue and the greater challenge is the need for early HIV diagnosis and provision of appropriate longitudinal HIV care prior to ART eligibility.