scholarly journals Causes of death and associated factors over a decade of follow-up in a cohort of people living with HIV in rural Tanzania

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Getrud Joseph Mollel ◽  
Lilian Moshi ◽  
Hoda Hazem ◽  
Anna Eichenberger ◽  
Olivia Kitau ◽  
...  
Keyword(s):  
Associated Factors ◽  
Causes Of Death ◽  
Proportional Hazards ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Factors Associated ◽  
Rural Tanzania ◽  
Living With Hiv ◽  
Related Mortality

Abstract Background Nearly half of HIV-related deaths occur in East and Southern Africa, yet data on causes of death (COD) are scarce. We determined COD and associated factors among people living with HIV (PLHIV) in rural Tanzania. Methods PLHIV attending the Chronic Diseases Clinic of Ifakara, Morogoro are invited to enrol in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO). Among adults (≥ 15 years) enrolled in 2005–2018, with follow-up through April 2019, we classified COD in comprehensive classes and as HIV- or non-HIV-related. In the subset of participants enrolled in 2013–2018 (when data were more complete), we assessed cause-specific mortality using cumulative incidences, and associated factors using proportional hazards models. Results Among 9871 adults (65% female, 26% CD4 count < 100 cells/mm3), 926 (9%) died, among whom COD were available for 474 (51%), with missing COD mainly in earlier years. The most common COD were tuberculosis (N = 127, 27%), non-AIDS-related infections (N = 72, 15%), and other AIDS-related infections (N = 59, 12%). Cardiovascular and renal deaths emerged as important COD in later calendar years, with 27% of deaths in 2018 attributable to cardiovascular causes. Most deaths (51%) occurred within the first six months following enrolment. Among 3956 participants enrolled in 2013–2018 (N = 203 deaths, 200 with COD ascertained), tuberculosis persisted as the most common COD (25%), but substantial proportions of deaths from six months after enrolment onwards were attributable to renal (14%), non-AIDS-related infections (13%), other AIDS-related infections (10%) and cardiovascular (10%) causes. Factors associated with higher HIV-related mortality were sex, younger age, living in Ifakara town, HIV status disclosure, hospitalisation, not being underweight, lower CD4 count, advanced WHO stage, and gaps in care. Factors associated with higher non-HIV-related mortality included not having an HIV-positive partner, lower CD4 count, advanced WHO stage, and gaps in care. Conclusion Incidence of HIV-related mortality was higher than that of non-HIV-related mortality, even in more recent years, likely due to late presentation. Tuberculosis was the leading specific COD identified, particularly soon after enrolment, while in later calendar years cardiovascular and renal causes emerged as important, emphasising the need for improved screening and management.

scholarly journals Prevalence and Evolution of Renal Impairment in People Living With HIV in Rural Tanzania

2018 ◽  
Vol 5 (4) ◽  
Author(s):  
Herry Mapesi ◽  
Aneth V Kalinjuma ◽  
Alphonce Ngerecha ◽  
Fabian Franzeck ◽  
Christoph Hatz ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Renal Impairment ◽  
Older Age ◽  
Cd4 Count ◽  
Noncommunicable Disease ◽  
World Health ◽  
People Living With Hiv ◽  
Rural Tanzania ◽  
Living With Hiv

Abstract Background We assessed the prevalence, incidence, and predictors of renal impairment among people living with HIV (PLWHIV) in rural Tanzania. Methods In a cohort of PLWHIV aged ≥15 years enrolled from January 2013 to June 2016, we assessed the association between renal impairment (estimated glomerural filtration rate &lt; 90 mL/min/1.73 m2) at enrollment and during follow-up with demographic and clinical characteristcis using logistic regression and Cox proportional hazards models. Results Of 1093 PLWHIV, 172 (15.7%) had renal impairment at enrollment. Of 921 patients with normal renal function at baseline, 117 (12.7%) developed renal impairment during a median follow-up (interquartile range) of 6.2 (0.4–14.7) months. The incidence of renal impairment was 110 cases per 1000 person-years (95% confidence interval [CI], 92–132). At enrollment, logistic regression identified older age (adjusted odds ratio [aOR], 1.79; 95% CI, 1.52–2.11), hypertension (aOR, 1.84; 95% CI, 1.08–3.15), CD4 count &lt;200 cells/mm3 (aOR, 1.80; 95% CI, 1.23–2.65), and World Health Organization (WHO) stage III/IV (aOR, 3.00; 95% CI, 1.96–4.58) as risk factors for renal impairment. Cox regression model confirmed older age (adjusted hazard ratio [aHR], 1.85; 95% CI, 1.56–2.20) and CD4 count &lt;200 cells/mm3 (aHR, 2.05; 95% CI, 1.36–3.09) to be associated with the development of renal impairment. Conclusions Our study found a low prevalence of renal impairment among PLWHIV despite high usage of tenofovir and its association with age, hypertension, low CD4 count, and advanced WHO stage. These important and reassuring safety data stress the significance of noncommunicable disease surveillance in aging HIV populations in sub-Saharan Africa.

Impact of hepatitis C virus antibody positivity on mortality and causes of death in people living with HIV in Georgia

2019 ◽  
Vol 30 (12) ◽  
pp. 1185-1193
Author(s):  
Nikoloz Chkhartishvili ◽  
Natalia Bolokadze ◽  
Nino Rukhadze ◽  
Natia Dvali ◽  
Akaki Abutidze ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
People Living With Hiv ◽  
Hcv Therapy ◽  
Living With Hiv ◽  
Related Mortality

Hepatitis C co-infection in people living with HIV (PLWH) is common in Georgia. Antiretroviral therapy (ART) is widely available in the country since 2004, and from 2011, patients have unlimited access to hepatitis C virus (HCV) treatment. A retrospective nationwide cohort study included adult PLWH diagnosed between 2004–2016, who were followed up until 31 December 2017. Predictors of mortality were assessed in Cox proportional hazards regression model. A total of 4560 persons contributed 22,322 person-years (PY) of follow-up, including 2058 (45.1%, 10,676 PY) anti-HCV+ patients. After the median 4.1 years of follow-up, 954 persons died, including 615 anti-HCV+ patients. Persons with HCV had higher overall mortality compared to HIV monoinfection (5.76/100 PY vs. 2.91/100 PY, p < 0.0001). In multivariable analysis, anti-HCV positivity was significantly associated with mortality (adjusted hazard ratio: 1.42, 95% CI: 1.09–1.85). Among anti-HCV+ persons, liver-related mortality due to viral hepatitis before the availability of HCV therapy (2004–2011) was 2.11 cases per 100 PY and this decreased to 0.79 cases per 100 PY after 2011 (p < 0.0001). AIDS remained the leading cause of death prior to and after 2011. Wide availability of ART and anti-HCV therapy translated into a significant decline in mortality including due to liver-related causes. Improving earlier diagnosis will decrease excess AIDS-related mortality among people living with HIV/HCV co-infection.

scholarly journals Food insecurity and associated factors among people living with HIV/AIDS on follow up receiving anti-retroviral therapy at public hospitals of Wollega zones, Oromia, Ethiopia, 2019

2019 ◽  
Author(s):  
Adugna Oluma ◽  
Muktar Abadiga ◽  
Getu Mosisa ◽  
Werku Etafa ◽  
Ginenus Fekadu
Keyword(s):  
Cigarette Smoking ◽  
Food Insecurity ◽  
Associated Factors ◽  
Dietary Diversity ◽  
Public Hospitals ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Living With Hiv ◽  
Hiv Aids

Abstract Background : Food insecurity and HIV/AIDS are intertwined in a vicious cycle through nutritional, mental health, and behavioral pathways. Food insecurity is a potentially important barrier to the success of antiretroviral treatment, increased hospitalizations, and higher morbidity among HIV-infected individuals in resource-poor settings particularly in sub-Saharan Africa including Ethiopia. Therefore, the purpose of this study was to assess the prevalence of food insecurity and its associated factors among adult people living with HIV/AIDS on follow up receiving ART at public hospitals of wollega zone, west Ethiopia. Methods : An institutional-based cross-sectional study design was conducted on a sample of 428 among people living with HIV/AIDS on follow up receiving anti-retroviral therapy at public hospitals of wollega zones. Data was collected using the Household Food Insecurity Access Scale and dietary diversity scale by interviewer-administered questionnaires. The data was checked, cleaned and entered into Epi data version 3.1 and then exported into Statistical Package for the Social Sciences (SPSS) window version 21 for analysis. Descriptive statistics - cross-tabulation frequency table, mean, standard deviation, percentage, were employed. Bivariate and multiple logistic regression analyses were used with AOR at CI 95% and p<0.05 were used. Result: The overall prevalence of food insecurity among PLWHA receiving ART therapy was 68.8% which was partitioned as mild (23.32%), moderate (29.09%) and severe (16.35%) food in secured. Being single [AOR=3.507(1.377, 8.934)], illiterate [AOR=5.234(1.747, 15.686)], cigarette smoking [AOR=3.577(2.104, 6.081)], presence of anemia (AOR=2.650(1.563, 4.493)] and inadequate dietary diversity [AOR=2.870(1.088, 7.569)] were predictors of food insecurity. Conclusion : The prevalence of food insecurity was relatively high. Educational status, marital status, cigarette smoking, presence of anemia, opportunistic infection and inadequate dietary diversity were the major significant factors affecting food insecurity. We recommended Wollega Zonal Health Bureaus to effectively intervene in behavioral modification and health information dissemination (HID) which is the key strategies to improve food security.

scholarly journals Predictors of overall mortality among people living with HIV/AIDS in Brazil, 2007-2015

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M E Santos ◽  
R A Ribeiro ◽  
C Protopopescu ◽  
M Nishimwe ◽  
I Yaya ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Hiv Infection ◽  
Risk Group ◽  
National Database ◽  
People Living With Hiv ◽  
Factors Associated ◽  
Living With Hiv ◽  
Overall Mortality ◽  
Hiv Aids

Abstract Background In Brazil there are 926,742 people living with HIV/AIDS (PLWHA). Despite the introduction of antiretroviral therapy (ART) in 1996 and treatment for all in 2014, mortality has increased in some regions. This study aimed to estimate the factors associated with overall mortality in PLWHA to recommend public health actions. Methods We studied PLWHA aged ≥18 years old, followed-up from 2007 to 2015 in the universal health system in Brazil. We used a national database (disease reporting, laboratory tests, ART and death notifications). Kaplan-Meier method and Cox model were used in survival analysis. The outcome was all-cause deaths. The explanatory variables measured at baseline were sociodemographic characteristics, HIV transmission mode and coinfections by hepatitis B (HBV) and C (HCV). The time-varying variables were CD4 cell count, viral load (VL) and ART status. Results Study population (n = 411,281) was mainly male (61%), under 40 years old (61%), Caucasian (37%), with basic education (43%), heterosexual HIV-infection mode (41%), resident in Southeast region (48%). The co-infection rate was 2.5% for HCV, and 1.4% for HBV. Median time to ART initiation was 83 days. During the follow-up period (median: 4 years), 61,757 deaths occurred (6% HCV-coinfected and 2% HBV-coinfected). The global mortality rate was 3.44 [95% confidence interval: 3.42-3.47] per 100 person-years (PY) during 1,793,417 PY. The factors associated with increased mortality in multivariable analyses were male gender, age over 40, non-Caucasian race, HIV infection by drug use, resident in North, Northeast and South regions, HCV and HBV coinfection, VL ≥ 200 copies/mL and starting ART with CD4&lt;200 cells/mm3. Conclusions Although PLWHA start ART in less than 3 months after the beginning of follow-up, there is still late treatment (at CD4&lt;200 cells/mm3). Screening should target all populations regardless of risk group. Coinfected individuals should also be early treated for HCV and HBV infections. Key messages The results of our study show that all populations should be target for HIV screening regardless of risk group. PLWHA coinfected with hepatitis B and hepatitis C should be also early treated for hepatitis coinfections.

scholarly journals Determinants of AIDS and non-AIDS related mortality among people living with HIV in Shiraz, southern Iran: a 20-year retrospective follow-up study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zahra Gheibi ◽  
Zahra Shayan ◽  
Hassan Joulaei ◽  
Mohammad Fararouei ◽  
Shohreh Beheshti ◽  
...  
Keyword(s):  
Immune Deficiency Syndrome ◽  
Older Age ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Mena Region ◽  
Infected People ◽  
Clinical Stages ◽  
Living With Hiv ◽  
Related Mortality

Abstract Background Human Immunodeficiency Virus (HIV) infection has become a global concern. Determining the factors leading to death among HIV patients helps controlling Acquired Immune Deficiency Syndrome (AIDS) epidemic. Up to now, little is known about mortality and its determinants among people living with HIV in the Middle East and North Africa (MENA) region, including Iran. The purpose of this study was to assess the risk factors of AIDS-Related Mortality (ARM) and Non-AIDS-Related Mortality (NARM) among people with HIV in Iran. Methods This 20-year retrospective study was conducted on 1160 people with HIV whose data were collected from 1997 to 2017. The association of the study outcomes (ARM and NARM) with various study variables, including demographic status at the time of diagnosis and clinical indexes during the follow-up were examined to define the predictors of mortality among the patients. Regarding, Cox proportional hazard and competing risk models were fitted and Adjusted Hazard Ratios (AHR), Sub-distribution Hazard Ratio (SHR) and the 95% Confidence Intervals (CI) were reported. Results during the follow-up period, 391 individuals (33.7%) died with 86,375 person-years of follow-up. Of the total deaths, 251 (64.2%) and 140 (35.8%) were ARM and NARM, respectively. Rates of the mortality caused by AIDS and non-AIDS were 3.2 and 4.5 per 1000 person-months, respectively. Responding to combined Antiretroviral Treatment (cART) 6 months after initiation, receiving Pneumocystis Pneumonia (PCP) prophylaxis, and higher CD4 count at diagnosis, reduced the hazard of ARM and NARM. However, older age, late HIV diagnosis, and last HIV clinical stages increased the hazard of AIDS related to mortality. Additionally, male gender, older age, incarceration history, and last HIV clinical stages increased the non-AIDS mortality. Conclusions Mortality caused by AIDS and non-AIDS remains high among people with HIV in Iran, particularly among males and those with late diagnosis. It seems that applying effective strategies to identify infected individuals at earlier stage of the infection, and targeting individuals with higher risk of mortality can decrease the mortality rate among HIV infected people.

scholarly journals Social support status and associated factors among people living with HIV/AIDS in Kunming city, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi Li ◽  
Xiao-Wen Zhang ◽  
Bin Liao ◽  
Jun Liang ◽  
Wen-Jie He ◽  
...  
Keyword(s):  
Social Support ◽  
Antiretroviral Therapy ◽  
Associated Factors ◽  
Support Network ◽  
People Living With Hiv ◽  
Monthly Income ◽  
Factors Associated ◽  
The Social ◽  
Living With Hiv ◽  
Hiv Aids

Abstract Background People living with HIV/AIDS not only require effective treatment for the alleviation of physical discomfort but also require social support to help them address difficulties in life and relieve their psychological anxiety and uneasiness. The social support network is of tremendous importance in helping people living with HIV/AIDS maintain good physical and mental health. This study aims to analyse the social support status among people living with HIV/AIDS in Kunming and explore associated factors. Method The Social Support Rating Scale (SSRS) was used, and a questionnaire survey was conducted using convenience sampling to select people living with HIV/AIDS from 14 counties of Kunming. It collected information on general demographic information and social support status. Univariate and multivariate linear regression models were used to explore the associated factors. Results A total of 990 valid questionnaires were completed. Data from all participants were analysed. Univariate analysis suggested that the factors associated with social support may include marital status, monthly income, and antiretroviral therapy. On the other hand, factors including monthly income and antiretroviral therapy accounted for the social support total score in the multivariate analysis. Conclusion Social support among people living with HIV/AIDS in Kunming was generally low. This study identified a number of factors associated with social support among people living with HIV/AIDS. Based on our findings, appropriate interventions should be introduced to provide social support for those living with HIV/AIDS.

scholarly journals Virologic Outcomes among People Living with HIV with High Pre-Therapy Viral Load Burden Initiating on Common Core Agents

2021 ◽  
Author(s):  
Anthony M Mills ◽  
Kathy L Schulman ◽  
Jennifer S Fusco ◽  
Michael B Wohlfeiler ◽  
Julie L Priest ◽  
...  
Keyword(s):  
Common Core ◽  
Virologic Failure ◽  
People Living With Hiv ◽  
Factors Associated ◽  
Viral Loads ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Living With Hiv ◽  
Cd4 Cell

Abstract Background People living with HIV (PLWH) initiating antiretroviral therapy (ART) with viral loads (VL) ≥100,000 copies/mL are less likely to achieve virologic success, but few studies have characterized real-world treatment outcomes. Methods ART-naïve PLWH with VLs ≥100,000 copies/mL initiating dolutegravir (DTG), elvitegravir (EVG), raltegravir (RAL) or darunavir (DRV) between 12Aug2013 and 31July2017 were identified from the OPERA Database. Virologic failure was defined as (i) 2 consecutive VLs ≥200 copies/mL after 36 weeks of ART, or (ii) 1 VL ≥200 copies/mL with core agent discontinuation after 36 weeks, or (iii) 2 consecutive VL ≥200 copies/mL after suppression (≤50 copies/mL) before 36 weeks, or (iv) 1 VL ≥200 copies/mL with discontinuation after suppression before 36 weeks. Cox modelling estimated the association between regimen and virologic failure. Results There were 2,038 ART-naïve patients with high VL who initiated DTG (36%), EVG (46%), DRV (16%) or RAL (2%). Median follow-up was 18.1 months (IQR:12.4-28.9). EVG and DTG initiators were similar at baseline but RAL initiators were older and more likely to be female with low CD4 cell counts while DRV initiators differed notably on factors associated with treatment failure. Virologic failure was experienced by 9.2% DTG, 13.2% EVG, 18.4% RAL and 18.8% DRV initiators. Compared to DTG, the adjusted hazard ratio (95% CI) was 1.46 (1.05, 2.03) for EVG, 2.24 (1.50, 3.34) for DRV, and 4.13 (1.85, 9.24) for RAL. Conclusion ART-naïve PLWH with high VLs initiating on DTG were significantly less likely to experience virologic failure compared to EVG, RAL and DRV initiators.

scholarly journals Social support status and associated factors among people living with HIV/AIDS in Kunming city,China

2020 ◽  
Author(s):  
Yi Li ◽  
Xiao Wen Zhang ◽  
Bin Liao ◽  
Jun Liang ◽  
Wen Jie He ◽  
...  
Keyword(s):  
Social Support ◽  
Associated Factors ◽  
Univariate Analysis ◽  
Support Network ◽  
People Living With Hiv ◽  
Monthly Income ◽  
Factors Associated ◽  
The Social ◽  
Living With Hiv ◽  
Hiv Aids

Abstract Background HIV/AIDS not only need effective treatment to alleviate their physical discomforts, but also need social support to help them solve their life difficulties and relieve their psychological anxiety and uneasiness.Social support network is of great significance to help HIV/AIDS maintain good physical and mental health.This study aims to analyse the social support status among people living with HIV/AIDS in Kunming and explore the associated factors. Method A Social Support Rating Scale(SSRS) was used,and the questionnaire survey was conducted by using the method of convenient sampling to select HIV/AIDS from 14 county of Kunming city.It collected information on general demographic information and social support status.Univariate and multivariate linear regressions models were used to explore the associated factors. Results A total of 990 valid questionnaires were completed.Data from all patients were analyzed. Univariate analysis suggested that the factors associated with social support may include marital status,monthly income,antiretroviral therapy.On the other hand, factors including monthly income and antiretroviral therapy account for social support total score in multivariate analysis. Conclusion The social support of HIV/AIDS in Kunming was generally low. This study identified a number of factors associated with social support among HIV/AIDS.Based on our findings,appropriate interventions should be introduced to provide social support for HIV/AIDS.

scholarly journals Burden of Fatigue among Adults Living with HIV/AIDS Attending Antiretroviral Therapy in Ethiopia

2020 ◽  
Author(s):  
Tsiwaye Gebreyesus ◽  
Addisalem Belay ◽  
Gebretsadik Berhe ◽  
Gebremedhin Haile
Keyword(s):  
Clinical Stage ◽  
Health Care Service ◽  
Cd4 Count ◽  
Stage Ii ◽  
People Living With Hiv ◽  
Aids Patients ◽  
Physically Active ◽  
Factors Associated ◽  
Living With Hiv ◽  
Hiv Aids

Abstract Background: Fatigue is one of the most common and devastating Human Immuno-deficiency Virus (HIV) - related symptoms, with a varying prevalence in different study areas. In Ethiopia, there is a paucity of information on the magnitude and factors associated with fatigue among HIV/Acquired Immune Deficiency Syndrome (AIDS) patients. This may lead to under-diagnosis and eventually under-management of the symptom. Methods: Institution based cross-sectional study design was conducted among 609 HIV/AIDS patients who were selected by using a systematic random sampling method. Data were collected by using interviewer administered structured questionnaire. Level of fatigue was measured by Fatigue Severity Scale. Results: The prevalence of fatigue was found to be 51.7%. The factors associated with fatigue were: Parity [AOR= 2.01; 95% CI: 1.09-3.71], CD4 count 200-499 cells/mm3 [AOR= 2.81; 95% CI: 1.58-4.99], anemia [AOR= 4.90 95% CI: 2.40-9.97], co-morbidities [AOR= 3.65; 95% CI: 1.71-7.78], depression [AOR= 3.68 95% CI: 1.99-6.79], not being physically active [AOR= 3.20 95% CI: 1.50-6.81], clinical stage II or IV HIV [AOR= 3.11; 95% CI: 1.51-6.40] and [AOR= 4.08; 95% CI: 1.37-12.14], respectively. Conclusion: The finding of this study revealed that fatigue is a common health problem among adult People Living with HIV (PLHIV). Factors associated with fatigue included: Parity, CD4 count 200-499 cells/mm3, Clinical Stage II or IV HIV, anemia, co-morbidities, depression, and not being physically active. The health care service needs to address the predisposing factors by provision integrated care including timely detection and treatment of comorbidities, mental health problems, and promote physical activity to slow down disease progression and then reduce exposure to fatigue.

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