Mortality and its determinants among patients infected with HIV-1 on antiretroviral therapy in a referral centre in Yaounde, Cameroon: a retrospective cohort study
Open Access
- 13 July 2013
- Vol. 3 (7), e003210
- https://doi.org/10.1136/bmjopen-2013-003210
Abstract
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/mm3 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.This publication has 15 references indexed in Scilit:
- Non-adherence to antiretroviral therapy in Yaounde: Prevalence, determinants and the concordance of two screening criteriaJournal of Infection and Public Health, 2013
- Predictors of 5-Year Mortality in HIV-Infected Adults Starting Highly Active Antiretroviral Therapy in ThailandJAIDS Journal of Acquired Immune Deficiency Syndromes, 2012
- Early Mortality in Adults Initiating Antiretroviral Therapy (ART) in Low- and Middle-Income Countries (LMIC): A Systematic Review and Meta-AnalysisPLOS ONE, 2011
- Determinants and causes of mortality in HIV-infected patients receiving antiretroviral therapy in Burkina Faso: a five-year retrospective cohort studyAIDS Care, 2011
- First-line antiretroviral therapy and dyslipidemia in people living with HIV-1 in Cameroon: a cross-sectional studyAIDS Research and Therapy, 2011
- Determinants of survival in AIDS patients on antiretroviral therapy in a rural centre in the Far‐North Province, CameroonTropical Medicine & International Health, 2009
- Excessive Early Mortality in the First Year of Treatment in HIV Type 1-Infected Patients Initiating Antiretroviral Therapy in Resource-Limited SettingsAIDS Research and Human Retroviruses, 2008
- Mortality in the Highly Active Antiretroviral Therapy EraJAIDS Journal of Acquired Immune Deficiency Syndromes, 2006
- Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countriesThe Lancet, 2006
- Antiretroviral Therapy in Public and Private Routine Health Care Clinics in Cameroon: Lessons from the Douala Antiretroviral (DARVIR) InitiativeClinical Infectious Diseases, 2005