SURVIVAL AND PREDICTORS OF THE SURVIVAL OF HIV-INFECTED ADULT PATIENTS TAKING HAART AT HAWASSA UNIVERSITY REFERRAL HOSPITAL

Abstract

Introduction: The discovery of the combined antiretroviral therapy was a turning point which changed the outlook about AIDS
from a virtually death sentence to a manageable chronic disease. Although the field of HIV medicine is rapidly changing, there
is lack of recent knowledge about the survival and the predictors of the survival of HIV-infected patients taking HAART in the
study area.
Objective: To assess the predictors of the survival of patients living with HIV/AIDS who are taking highly active antiretroviral
therapy.
Methods: Retrospective three-year follow up (cohort) study was employed for randomly selected 436 HIV infected adult patients who were HAART initiated at Hawassa University Referral Hospital. Data was collected from the patients’ records by
trained BSc. nurses who used a pretested and structured checklist. The Kaplan-Meier and the Cox proportional hazards model
were used to estimate survival after HAART initiation and to identify predictors, respectively. Descriptive summary statistics,
bivariate, and multivariate regression analyses were used for significance tests.
Result: Two hundred fifty-seven (58.9%) study subjects were females and the median age of patients was 31years (IQR=27-39).
Three hundred and twelve (71.5%) of the subjects were below 10th grade in educational status with 199 (45.6%) ambulatory
and bedridden in functional status, 413 (94.7%) in stages III & IV at the initiation of ART. Two hundred eighty-five (65.4%) of
the patients had a CD4 cell count of less than 200cells/µl, and there were a total of 52 deaths during the follow up period of
which 32 (61.5%) & 42 (80.8%) died within the first three and six months of initiation of therapy, respectively. The cumulative
probabilities of survival of these patients were 90%, 88%, 87.5% and 87% at 6, 12, 24 and 36 months, respectively. Male sex
(HR=1.961, P-value=0.038), bedridden (HR=6.023, P-value<0.001) functional status, CD4 count below 50cells/µl (HR=3.388,
P-value=0.012), not using Cotrimoxazole chemoprophylaxis (HR=2.883, P-value= 0.018) and hemoglobin level below 10mg/dl
(HR=6.393, P-value<0.001) were statistically significant predictors of survival, indicating that being male, bedridden, CD4
count of less than 50cells/µl, not using chemoprophylaxis, and hemoglobin level <10mg/dl increase the risk of death of HIV
infected patients who are taking ART with respective hazard ratios.
Conclusion: Delayed initiation of ART and not using chemoprophylaxis are poor prognostic factors of survival for HIV/AIDS
patients.