Comparison of predictors for early and late mortality in adults commencing HIV antiretroviral therapy in Zimbabwe: a retrospective cohort study
Abstract Background People living with HIV (PLWHIV) commencing antiretroviral therapy (ART) in sub-Saharan Africa experience significant mortality within the first year. Previously, identified risk factors for mortality may be biased towards these patients, as compared to those who experience late m...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | AIDS Research and Therapy |
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| Online Access: | https://doi.org/10.1186/s12981-022-00445-4 |
| _version_ | 1818206689448427520 |
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| author | Bradley W. Byers Douglas Drak Tinei Shamu Cleophas Chimbetete Rumbi Dahwa David M. Gracey |
| author_facet | Bradley W. Byers Douglas Drak Tinei Shamu Cleophas Chimbetete Rumbi Dahwa David M. Gracey |
| author_sort | Bradley W. Byers |
| collection | DOAJ |
| description | Abstract Background People living with HIV (PLWHIV) commencing antiretroviral therapy (ART) in sub-Saharan Africa experience significant mortality within the first year. Previously, identified risk factors for mortality may be biased towards these patients, as compared to those who experience late mortality. Aim To compare risk factors for early and late mortality in PLWHIV commencing ART. Methods A retrospective cohort study of ART-naïve patients aged ≥ 18 years from an outpatient HIV clinic in Zimbabwe. Data were collected between January 2010 and January 2019. Predictors for early (≤ 1 year) and late mortality (> 1 year) were determined by multivariable cox proportional hazards analyses, with patients censored at 1 year and landmark analysis after 1 year, respectively. Results Three thousand and thirty-nine PLWHIV were included in the analysis. Over a median follow-up of 4.6 years (IQR 2.5–6.9), there was a mortality rate of 8.8%, with 50.4% of deaths occurring within 1 year. Predictors of early mortality included CD4 count < 50 cells/µL (HR 1.84, 95% CI 1.24–2.72, p < 0.01), WHO Stage III (HR 2.05, 95% CI 1.28–3.27, p < 0.01) or IV (HR 2.83, 95% CI 1.67–4.81, p < 0.01), and eGFR < 90 mL/min/1.73 m2 (HR 2.48, 95% CI 1.56–3.96, p < 0.01). Other than age (p < 0.01), only proteinuria (HR 2.12, 95% CI 1.12–4.01, p = 0.02) and diabetes mellitus (HR 3.51, 95% CI 1.32–9.32, p = 0.01) were associated with increased risk of late mortality. Conclusions Traditional markers of mortality risk in patients commencing ART appear to be limited to early mortality. Proteinuria and diabetes are some of the few predictors of late mortality, and should be incorporated into routine screening of patients commencing ART. |
| first_indexed | 2024-12-12T04:17:01Z |
| format | Article |
| id | doaj.art-492c75cf9b834df4a53c2df65857b905 |
| institution | Directory Open Access Journal |
| issn | 1742-6405 |
| language | English |
| last_indexed | 2024-12-12T04:17:01Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | AIDS Research and Therapy |
| spelling | doaj.art-492c75cf9b834df4a53c2df65857b9052022-12-22T00:38:26ZengBMCAIDS Research and Therapy1742-64052022-05-011911610.1186/s12981-022-00445-4Comparison of predictors for early and late mortality in adults commencing HIV antiretroviral therapy in Zimbabwe: a retrospective cohort studyBradley W. Byers0Douglas Drak1Tinei Shamu2Cleophas Chimbetete3Rumbi Dahwa4David M. Gracey5Central Clinical School, Faculty of Medicine, The University of SydneyCentral Clinical School, Faculty of Medicine, The University of SydneyNewlands ClinicNewlands ClinicFaculty of Medicine and Health Sciences, University of ZimbabweCentral Clinical School, Faculty of Medicine, The University of SydneyAbstract Background People living with HIV (PLWHIV) commencing antiretroviral therapy (ART) in sub-Saharan Africa experience significant mortality within the first year. Previously, identified risk factors for mortality may be biased towards these patients, as compared to those who experience late mortality. Aim To compare risk factors for early and late mortality in PLWHIV commencing ART. Methods A retrospective cohort study of ART-naïve patients aged ≥ 18 years from an outpatient HIV clinic in Zimbabwe. Data were collected between January 2010 and January 2019. Predictors for early (≤ 1 year) and late mortality (> 1 year) were determined by multivariable cox proportional hazards analyses, with patients censored at 1 year and landmark analysis after 1 year, respectively. Results Three thousand and thirty-nine PLWHIV were included in the analysis. Over a median follow-up of 4.6 years (IQR 2.5–6.9), there was a mortality rate of 8.8%, with 50.4% of deaths occurring within 1 year. Predictors of early mortality included CD4 count < 50 cells/µL (HR 1.84, 95% CI 1.24–2.72, p < 0.01), WHO Stage III (HR 2.05, 95% CI 1.28–3.27, p < 0.01) or IV (HR 2.83, 95% CI 1.67–4.81, p < 0.01), and eGFR < 90 mL/min/1.73 m2 (HR 2.48, 95% CI 1.56–3.96, p < 0.01). Other than age (p < 0.01), only proteinuria (HR 2.12, 95% CI 1.12–4.01, p = 0.02) and diabetes mellitus (HR 3.51, 95% CI 1.32–9.32, p = 0.01) were associated with increased risk of late mortality. Conclusions Traditional markers of mortality risk in patients commencing ART appear to be limited to early mortality. Proteinuria and diabetes are some of the few predictors of late mortality, and should be incorporated into routine screening of patients commencing ART.https://doi.org/10.1186/s12981-022-00445-4HIVAnti-retroviral therapyMortalityCD4 countZimbabweSub-Saharan Africa |
| spellingShingle | Bradley W. Byers Douglas Drak Tinei Shamu Cleophas Chimbetete Rumbi Dahwa David M. Gracey Comparison of predictors for early and late mortality in adults commencing HIV antiretroviral therapy in Zimbabwe: a retrospective cohort study AIDS Research and Therapy HIV Anti-retroviral therapy Mortality CD4 count Zimbabwe Sub-Saharan Africa |
| title | Comparison of predictors for early and late mortality in adults commencing HIV antiretroviral therapy in Zimbabwe: a retrospective cohort study |
| title_full | Comparison of predictors for early and late mortality in adults commencing HIV antiretroviral therapy in Zimbabwe: a retrospective cohort study |
| title_fullStr | Comparison of predictors for early and late mortality in adults commencing HIV antiretroviral therapy in Zimbabwe: a retrospective cohort study |
| title_full_unstemmed | Comparison of predictors for early and late mortality in adults commencing HIV antiretroviral therapy in Zimbabwe: a retrospective cohort study |
| title_short | Comparison of predictors for early and late mortality in adults commencing HIV antiretroviral therapy in Zimbabwe: a retrospective cohort study |
| title_sort | comparison of predictors for early and late mortality in adults commencing hiv antiretroviral therapy in zimbabwe a retrospective cohort study |
| topic | HIV Anti-retroviral therapy Mortality CD4 count Zimbabwe Sub-Saharan Africa |
| url | https://doi.org/10.1186/s12981-022-00445-4 |
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