Mortality and its determinants among patients infected with HIV-1 on antiretroviral therapy in a referral centre in Yaounde, Cameroon: a retrospective cohort study

OBJECTIVES: Mortality has declined in people with HIV infection, subsequent to the improved access to antiretroviral therapy (ART). We assessed the incidence and determinants of mortality among patients with HIV-1 infection who were started on ART in a referral treatment centre for HIV infection in Yaounde, Cameroon. DESIGN: Cohort study with baseline assessment between 2007 and 2008, and follow-up during 5 years until June 2012. SETTING: The accredited HIV treatment centre of the Yaounde Jamot Hospital in the capital city of Cameroon. PARTICIPANTS: People living with HIV infection who started ART between 2007 and 2008 at the study centre. OUTCOME MEASURES: All-cause mortality over time; accelerated failure time models used to relate baseline characteristics to mortality occurrence during follow-up. RESULTS: Of the 1444 patients included, 827 (53.7%) were men, and the median age (25–75th centiles) was 38 (31–45) years. The median duration of follow-up was 14.1 (1.1–46.4) months, during which 235 deaths were recorded (cumulative incidence rate: 16.3%), including 208 (88.5%) during the first year of follow-up. Baseline predictors of mortality were male gender (adjusted HR 2.15 (95% CI 1.34 to 3.45)), active tuberculosis (2.35 (1.40 to 3.92)), WHO stages III–IV of the disease (3.63 (1.29 to 10.24)), low weight (1.03 (1.01 to 1.05)/kg), low CD4 count (1.04 (1.01 to 1.07)/10/mm(3) lower CD4) and low haemoglobin levels (1.12 (1.00 to 1.26)/g/dL lower). CONCLUSIONS: Mortality rate among patients with HIV is very high within the first year of starting ART in this centre. Early start of the treatment at a less advanced stage of the disease, and favourable levels of CD4 could reduce early mortality, but would have to be tested.