Survival on antiretroviral treatment among adult HIV-infected patients in Nepal: a retrospective cohort study in far-western Region, 2006–2011

BMC Infectious Diseases

Luai Awad Ahmed⁴  Anna Mia Ekstrom²  Deepak Kumar Karki⁵  Rachana Shrestha³  Keshab Deuba⁶  Elise Klouman¹  Laxmi Bhatta¹ 

[1] Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway;Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway;Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway;National Centre for AIDS and STD Control, Kathmandu, Nepal;Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

关键词: Asia;    Nepal;    Far-western region;    Determinants;    Mortality;    Antiretroviral treatment (ART);    HIV;   

Others  :  1135740
DOI  :  10.1186/1471-2334-13-604

 received in 2013-06-28, accepted in 2013-12-19,  发布年份 2013

【 摘 要 】

Background

Though financial and policy level efforts are made to expand antiretroviral treatment (ART) service free of cost, survival outcome of ART program has not been systematically evaluated in Nepal. This study assesses the mortality rates and determinants among adult HIV-infected patients on ART in Far-western region of Nepal.

Methods

This retrospective cohort study included 1024 (51.2% men) HIV-infected patients aged ≥15 years, who started ART between May 15^th 2006 and May 15^th 2011 in five ART sites in the Far-western region, Nepal. Follow-up time was calculated from the date of ART initiation to date of death or censoring (loss to follow-up, transferred out, or 15 November 2011). Mortality rates (per 100 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore determinants of mortality.

Results

The median follow-up time was 19.1 months. The crude mortality rate was 6.3 (95% confidence interval (CI) 5.3-7.6) but more than three-times higher in first 3 months after ART initiation (21.9 (95% CI 16.6- 28.8)). About 12% (83% men) of those newly initiated on ART died during follow-up. The independent determinants of mortality were male sex (hazard ratio (HR) 4.55, 95% CI 2.43-8.51), poor baseline performance scale (bedridden <50% of the day during the past month, HR 2.05, 95% CI 1.19-3.52; bedridden >50% of the day during the past month, HR 3.41, 95% CI 1.67-6.98 compared to normal activity), one standard deviation decrease in baseline bodyweight (HR 1.04, 95% CI 1.01-1.07), and poor WHO clinical stage (stage III, HR 2.96, 95% CI 1.31-6.69; stage IV, HR 3.28, 95% CI 1.30-8.29 compared to WHO clinical stage I or II).

Conclusions

High mortality was observed within the first 3 months of ART initiation. Patients with poor baseline clinical characteristics had higher mortality, especially men. Earlier initiation of ART through expanded testing and counselling should be encouraged in HIV-infected patients.

【 授权许可】

   
2013 Bhatta et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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