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Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study

BACKGROUND: In Ethiopia, the publicly funded antiretroviral treatment (ART) program was started in 2005. Two hundred seventy-five thousand patients were enrolled in the national ART program by 2012. However, there is limited data on mortality and predictors of death among adult patients in the ART p...

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Autores principales: Fekade, Daniel, Weldegebreal, Teklu, Teklu, Alula M, Damen, Melake, Abdella, Saro, Baraki, Nega, Belayhun, Bekele, Berhan, Eyoel, Kebede, Amha, Assefa, Yibeltal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Research and Publications Office of Jimma University 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402798/
https://www.ncbi.nlm.nih.gov/pubmed/28465654
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author Fekade, Daniel
Weldegebreal, Teklu
Teklu, Alula M
Damen, Melake
Abdella, Saro
Baraki, Nega
Belayhun, Bekele
Berhan, Eyoel
Kebede, Amha
Assefa, Yibeltal
author_facet Fekade, Daniel
Weldegebreal, Teklu
Teklu, Alula M
Damen, Melake
Abdella, Saro
Baraki, Nega
Belayhun, Bekele
Berhan, Eyoel
Kebede, Amha
Assefa, Yibeltal
author_sort Fekade, Daniel
collection PubMed
description BACKGROUND: In Ethiopia, the publicly funded antiretroviral treatment (ART) program was started in 2005. Two hundred seventy-five thousand patients were enrolled in the national ART program by 2012. However, there is limited data on mortality and predictors of death among adult patients in the ART program. The study aimed to estimate mortality and risk factors for death among adult, ART-naïve patients, started in the national ART program from January 2009 to July 2013. METHODS: Multi-site, prospective, observational cohort study of adult, age > 18 years, ART-naïve patients, started in the national ART program at seven university-affiliated hospitals from January 2009 – July 2013. Kaplan-Meier and Cox regression analyses were used to estimate survival and determine risk factors for death. RESULTS: A total of 976 patients, 594 females (60.9 %), were enrolled into the study. Median age of the cohort was 33years. The median CD4 count at start of ART was 144 cells/µl (interquartile range (IQR) 78–205), and 34.2% (330/965) had CD4 < 100. Sixty-three percent (536/851) had viral load greater than 5 log copies/ml (IQR 4.7–5.7) at base line. One hundred and one deaths were recorded during follow-up period, all-cause mortality rate 10.3%; 5.4 deaths/100 person years of observation, 95% confidence interval 4.4–6.5. Seventy percent of the deaths occurred within six months of starting ART. Cox regression analyses showed that the following measures independently predicted mortality: age >51 years, (Adjusted Hazard Ratio (AHR) 4.01, P=0.003), WHO stages III&IV, (AHR 1.76, p = 0.025), CD4 count, <100, (AHR 2.36, p =0.006), and viral load >5 log copies /ml (CHR 1.71, p = 0.037). CONCLUSION: There is high early on- ART mortality in patients presenting with advanced immunodeficiency. Detecting cases and initiating ART before onset of advanced immunodeficiency might improve survival.
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spelling pubmed-54027982017-05-02 Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study Fekade, Daniel Weldegebreal, Teklu Teklu, Alula M Damen, Melake Abdella, Saro Baraki, Nega Belayhun, Bekele Berhan, Eyoel Kebede, Amha Assefa, Yibeltal Ethiop J Health Sci Original Article BACKGROUND: In Ethiopia, the publicly funded antiretroviral treatment (ART) program was started in 2005. Two hundred seventy-five thousand patients were enrolled in the national ART program by 2012. However, there is limited data on mortality and predictors of death among adult patients in the ART program. The study aimed to estimate mortality and risk factors for death among adult, ART-naïve patients, started in the national ART program from January 2009 to July 2013. METHODS: Multi-site, prospective, observational cohort study of adult, age > 18 years, ART-naïve patients, started in the national ART program at seven university-affiliated hospitals from January 2009 – July 2013. Kaplan-Meier and Cox regression analyses were used to estimate survival and determine risk factors for death. RESULTS: A total of 976 patients, 594 females (60.9 %), were enrolled into the study. Median age of the cohort was 33years. The median CD4 count at start of ART was 144 cells/µl (interquartile range (IQR) 78–205), and 34.2% (330/965) had CD4 < 100. Sixty-three percent (536/851) had viral load greater than 5 log copies/ml (IQR 4.7–5.7) at base line. One hundred and one deaths were recorded during follow-up period, all-cause mortality rate 10.3%; 5.4 deaths/100 person years of observation, 95% confidence interval 4.4–6.5. Seventy percent of the deaths occurred within six months of starting ART. Cox regression analyses showed that the following measures independently predicted mortality: age >51 years, (Adjusted Hazard Ratio (AHR) 4.01, P=0.003), WHO stages III&IV, (AHR 1.76, p = 0.025), CD4 count, <100, (AHR 2.36, p =0.006), and viral load >5 log copies /ml (CHR 1.71, p = 0.037). CONCLUSION: There is high early on- ART mortality in patients presenting with advanced immunodeficiency. Detecting cases and initiating ART before onset of advanced immunodeficiency might improve survival. Research and Publications Office of Jimma University 2017-02 /pmc/articles/PMC5402798/ /pubmed/28465654 Text en Copyright © Jimma University, Research & Publications Office 2017 This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Original Article
Fekade, Daniel
Weldegebreal, Teklu
Teklu, Alula M
Damen, Melake
Abdella, Saro
Baraki, Nega
Belayhun, Bekele
Berhan, Eyoel
Kebede, Amha
Assefa, Yibeltal
Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study
title Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study
title_full Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study
title_fullStr Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study
title_full_unstemmed Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study
title_short Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study
title_sort predictors of survival among adult ethiopian patients in the national art program at seven university teaching hospitals: a prospective cohort study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402798/
https://www.ncbi.nlm.nih.gov/pubmed/28465654
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