Survival pattern and determinants of survival in adult HIV-infected patients on antiretroviral treatment in Far-western Development Region, Nepal

Abstract

Objective: This study explores the survival pattern and its determinants among adult HIV-infected patients on ART. Methods: This retrospective cohort study included 1024 (51.2% were men) HIV-infected patients aged ≥15 years who started ART between May 15, 2006 and May 15, 2011 in 5 ART centres in Nepal. Follow-up time was calculated from the date of ART initiation to date of death or censoring (loss to follow-up, transferred out, or 15th of November 2011). Mortality rates (per 100 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore determinants of mortality. Results: About 12% (83% of them were male) died during follow-up. The mortality rate was 21.9 (16.6- 28.8) within the first 3 months after ART initiation. The survival probability was 94.7% at 3 months and 82.9% at 5 years. The independent determinants of mortality were sex, performance scale, WHO clinical stage, and bodyweight. Higher mortality was significantly associated with bedridden performance status, advanced clinical disease, low bodyweight, and change in ART regimen in male patients; and with active tuberculosis and low bodyweight in female patients. Conclusion: High mortality was observed within the first 3 months of ART initiation. Patients with poor clinical characteristics had higher mortality, especially male. Early initiation of ART should be encouraged in HIV-infected patients.