DOI: https://doi.org/10.14710/dimj.v2i1.9667

Risk Factors for Mortality among HIV/AIDS Patients

Zaki Mita Kusumaadhi orcid  -  Medical Faculty of Diponegoro University / Dr Kariadi General Hospital Semarang, Indonesia, Indonesia
Nur Farhanah orcid  -  Division of Tropical and Infectious Disease, Department of Internal Medicine, Medical Faculty of Diponegoro University / Dr Kariadi General Hospital Semarang, Indonesia, Indonesia
*Muchlis Achsan Udji Sofro orcid  -  Division of Tropical and Infectious Disease, Department of Internal Medicine, Medical Faculty of Diponegoro University / Dr Kariadi General Hospital Semarang, Indonesia, Indonesia
Open Access Copyright (c) 2021 Diponegoro International Medical Journal
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Citation Format:
Abstract

Background: Morbidity and mortality of HIV/AIDS infections is still high and as  a global health problem particularly in Low-Middle Income Countries (LMICs). Indonesia ranks third in Asia Pacific in increasing HIV infection. A Study on risk factors for mortality in HIV/AIDS patients in Dr. Kariadi General Hospital has never been conducted. This study analyzed the risk factors for mortality among HIV/AIDS patients.

Methods: Case control study, data from medical records of inpatients and outpatients in Dr. Kariadi General Hospital from January 2015 to December 2017.

Results: Study subject: Two hundred and ten HIV/AIDS patients, were included; 105 (56.75%) as cases and 105 (9.65%) control patients. The significant risk factors for mortality were as follow: male sex (p = 0.030); age ≥ 45 years (p = 0.035); non compliance to treatment (p = 0,000); WHO clinical stage III and IV (p = 0,000); co-infection of pulmonary tuberculosis (p = 0,000); CD4 cell count < 200 cells/mm3 (p = 0,000); eGFR < 60 mL/minute/1.72 m2 (p = 0.001) and Haemoglobin level < 10 g/dL (p = 0.008). The non-significant risk factors for mortality were as follow: level of education (p = 0.650); Hepatitis B co-infection (p = 0.153) and Hepatitis C co-infection (p = 0.506). The most important risk factors for mortality in this study in were non compliance to treatment (p = 0.003; OR = 3.285) and CD4 count < 200 cells/mm3 (p = 0.014; OR = 5.480).

Conclusion: In this study, the risk factors for mortality in HIV/AIDS patients were male sex; age ≥ 45 years; non compliance to treatment; WHO clinical stage III and IV; co-infection of pulmonary tuberculosis, CD4 count < 200 cells/mm3; eGFR < 60 mL/minute/1.72 m2 and Hb level < 10 g/dL. The most important risk factors for mortality were non compliance to treatment and CD4 count < 200 cells / mm3.

Note: This article has supplementary file(s).

Fulltext View|Download |  Research Instrument
Risk Factors for Mortality among HIV/AIDS Patients
Subject
Type Research Instrument
  Download (59KB)    Indexing metadata
Keywords: HIV; Morbidity; Mortality; Risk
Funding: No specific funding was provided for this article

Article Metrics:

Article Info
Section: Original Research Article
Language : EN
Recent articles
Efficacy of Vitamin B1, B6, and B12 Forte Therapy in Peripheral Neuropathy Patients The Correlation Between Cobb’s Angle and Pedicle Rotation in Adolescent Idiopathic Scoliosis After Surgical Treatment The Effect of Using Blue Light Filter Feature on Smartphones with Asthenopia Occurrence More recent articles
  1. Hamidi O, Poorolajal J, Tapak L. Identifying predictors of progression to AIDS and mortality post-HIV infection using parametric multistate model. Journal of Epidemiology Biostatistics and Public Health 2017; 14(2): 34-40
  2. Kementerian Kesehatan RI. Situasi dan Analisis HIV/AIDS. Jakarta: Infodatin; 2016; 18
  3. Direktorat Jenderal Pencegahan dan Pengendalian Penyakit Kementerian Kesehatan Republik Indonesia. Laporan Perkembangan HIV-AIDS & Penyakit Infeksi Menular Seksual Triwulan I Tahun 2017: 4
  4. Sumantri R, Supandiman I, Indjradinata P, Ven D, Crevel V. Peluang Kematian Penderita Human Immunodeficiency Virus - Acquired Immune Deficiency Syndrome berdasarkan Gabungan Derajat Anemia, Indeks Massa Tubuh, dan Jumlah Cluster Differentiation 4. Jurnal FK Unpad 2012; 44(1): 50-6. https://doi.org/10.15395/mkb.v44n1.212
  5. Walubita L. The Predictive Value of Anaemia in Determining Mortality in Patients with HIV at The University Teaching Hospital, Lusaka, Zambia. A Dissertation. 2016: 6
  6. Utami S. Prediktor Kematian Pasien HIV/AIDS dengan Terapi Antiretroviral (ARV) di Rumah Sakit Umum Daerah Badung Bali Periode 2006-2014. Tesis.2015: 34
  7. Gunda W, Nkandala I, Kilonzo B, Kilangi B, Mpondo C. Prevalence and Risk Factors of Mortality among Adult HIV Patients Initiating ART in Rural Setting of HIV Care and Treatment Services in North Western Tanzania: A Retrospective Cohort Study. Journal of Sexually Transmitted Diseases 2017; 4(2): 1-8. https://doi.org/10.1155/2017/7075601
  8. Maskew M, Brennan T, Westreich D, McNamara L. Gender Differences in Mortality and CD4 Count Response Among Virally Supressed HIV-Positive Patients. Journal of Women's Health 2013; 22(2): 113-20. https://doi.org/10.1089/jwh.2012.3585
  9. Szotek L, Narasipura D, Harthi A. 17-β Estradiol Inhibits HIV-1 by Inducing a Complex Formation Between β-Catenin and Estrogen Receptor on The HIV Promoter to Suppress HIV Transcription. Journal of Virology 2013; 443(2): 1-21. https://doi.org/10.1016/j.virol.2013.05.027
  10. Garcia R, Biswas N, Patel V, Barr D, Crist G, Ochsenbauer, et al. Estradiol Reduces Susceptibility of CD4 T Cells and Macrophages to HIV-Infection. 2013. [cited 2017 December 21]. Available from: http//www.plosone.org
  11. Sharrow J, Collinson A, Tollman M, Clark J, Kahn K. The Age Pattern of Increases in Mortality Affected by HIV 2013; 2(39): 1039-96. https://doi.org/10.4054/DemRes.2013.29.39
  12. Rubaihayo J, Tumwesigye M, Lule K, Makumbi F, Nakku J, Wamani H, et al. Trends and Risk Factors of Mortality Among HIV Positive Patients in The Era of Highly Active Antiretroviral Therapy in Uganda. Infectious Disease Reports 2015; 7: 5967. https://doi.org/10.4081/idr.2015.5967
  13. Zheng L, Taiwo B, Gandhi T, Hunt W, Collier C, Flexner C, et al. Factors Associated with CD8+ T-Cell Activation in HIV-1-Infected Patients on Long-Term Antiretroviral Therapy. Journal Acquired Immune Deficiency Syndrome 2014; 67: 153-60. https://doi.org/10.1097/QAI.0000000000000286
  14. Nguyen N, Holodny M. HIV Infection in The Elderly. Clinical Intervention in Aging 2008; 3(3): 453-72. https://doi.org/10.2147/CIA.S2086
  15. Clark J, Thomas L. Age-Related Immune Dysfunction in Health and in Human Immunodeficiency Virus (HIV) Disease: Association of Age and HIV Infection with Naive CD8+ Cell Depletion, Reduced Expression of CD28 on CD8+ Cells, and Reduced Thymic Volumes. The Journal of Infectious Disease 2013; 187(12): 1924-33. https://doi.org/10.1086/375372
  16. Stringer J, Zulu I, Levy J, Stringer E, Mwango A, Chi H, et al. Rapid Scale-up of Antiretroviral Therapy at Primary Care Sites in Zambia. The Journal of the American Medical Association 2008; 296(7): 782-93. https://doi.org/10.1001/jama.296.7.782
  17. Ayalew B. Risk Factors for Mortality and Its Predictors among HIV Infected Patients Taking Antiretroviral Treatment in Ethiopia: A Systematic Review. AIDS Research and Treatment 2017; 1-10. https://doi.org/10.1155/2017/5415298
  18. Kenneth L. The Importance of Treatment Compliance in HIV. The American Journal of Managed Care 2013; 19: 231-37
  19. Utami S, Sawitri A, Putra E, Astuti P, Januraga P, Wulandari L, et al. Mortality Among HIV Patients on Antiretroviral Treatment (ART) in Bali, Indonesia 2006-2014. The Australian HIV & AIDS Conference 2015. Brisbane
  20. Mala E, Oberoi A. Opportunistic Infections in Relation to CD4 Counts in Human Immunodeficiency Virus Seropositive Patients in A Tertiary Care Hospital in North India. Journal of Health and Research 2015; 2: 199-202. https://doi.org/10.4103/2348-3334.158670
  21. Rajagopalan N, Suchitra B, Shet A, Khan K, Garcia M, Nonnemacher R, et al. Mortality Among HIV-Infected Patients in Resource Limited Settings: A Case Controlled Analysis of Inpatients at A Community Care Center. American Journal Infectious Disease 2009; 5(3): 1-10. https://doi.org/10.3844/ajidsp.2009.219.224
  22. Hamidi O, Tapak L, Poorolajal J, Amini P. Identifying Risk Factors for Progression to AIDS and Mortality Post-HIV Infection Using Illness-Death Multistate Model. Journal of Clinical Epidemiology and Global Health. 2017: 163-68; Available from: http://www.elsevier.com.https://doi.org/10.1016/j.cegh.2017.08.003
  23. Gjergji M, Bushati J, Harxhi J, Hafizi H, Pipero P. Tuberculosis in HIV/AIDS Patients. Journal of Epidemiology and Infectious Diseases 2017; 1: 1-7
  24. Kumar A, Kalakappa P. Spectrum of Opportunistic Infections with Correlation to CD4 Counts in Newly Diagnosed HIV Seropositive Cases. International Journal of Advances in Medicine 2017; 4(1): 252-58. https://doi.org/10.18203/2349-3933.ijam20170121
  25. Peraturan Menteri Kesehatan Republik Indonesia Nomor 87 Tahun 2014. Pedoman Pengobatan Antiretroviral; 9-25
  26. Garriga C, Garcia P, Miro J. Mortality, Causes of Death and Associated Factors Relate to a Large HIV Population -Based Cohort. 2015. [cited 2017 December 25]. Available from: www.journal.pone.0145701. https://doi.org/10.1371/journal.pone.0145701
  27. Chen L, Pan X, Jiang J. HIV Cause-Specific Deaths, Mortality, Risk Factors, and The Combined Influence of HAART and Late Diagnosis in Zhejiang, China, 2006-2013. Scientific Report 2017;7(42366):1-18. https://doi.org/10.1038/srep42366
  28. Ray W, Anthony K. Low CD4 Count as an Indicator of Disability. National Academy of Sciences 2017: 45-47
  29. Kim J, Ahn Y. The Prevalence and Risk Factors of Renal Insufficiency among Korean HIV-Infected Patients: The Korea HIV/AIDS Cohort Study. Journal of Infection and Chemotherapy 2017; 49(3): 194-204. https://doi.org/10.3947/ic.2017.49.3.194
  30. Longenecker T, Scherzer R, Bacchetti R, Lewis E, Grunfeld C, Shlipak C. HIV Viremia and Changes in Kidney Function. AIDS 2009; 23(9): 1089-96. https://doi.org/10.1097/QAD.0b013e32832a3f24
  31. Redig J, Berliner N. Pathogenesis and Clinical Implications of HIV -Related Anemia in 2013. Journal of American Society of Haematology 2013; 5(31): 377-82. https://doi.org/10.1182/asheducation-2013.1.377
  32. Damtew B, Mengistie B, Alemayehu T. Survival and Determinants of Mortality in Adult HIV/AIDS Patients Initiating Antiretroviral Therapy in Somali Region, Eastern Ethiopia. Pan African Medical Journal 2015; 22(138): 1-8. https://doi.org/10.11604/pamj.2015.22.138.4352
  33. Obirikorang C, Yeboah F. Blood Haemoglobin Measurements as A Predictive Indicator for The Progression of HIV/AIDS in Resource Limited Setting. Journal of Biomedical Science 2009; 16(102): 1-7. https://doi.org/10.1186/1423-0127-16-102
  34. Bhatta L, Klouman E, Deuba K, Shrestha R, Kumar D, Mia A, et al. Survival on Antiretroviral Treatment Among Adult HIV-Infected Patients in Nepal: A Retrospective Cohort Study in Far-Western Region, 2006-2011. BMC Infectious Diseases 2013; 13(604): 1-9. https://doi.org/10.1186/1471-2334-13-604
  35. Mahon J, Wanke C, Terrin N, Skinner S, Knox T. Poverty, Hunger, Education, and Residential Status Impact Survival in HIV. AIDS Behaviour 2011; 15(7): 1503-11. https://doi.org/10.1007/s10461-010-9759-z
  36. World Health Organization. HIV Treatment and Care: What's New in Treatment Monitoring Viral Load and CD4 Testing. Geneva: WHO Press; 2017; 1-2
  37. Knapp O, Cortes P, Saavedra F, Wolff M, Weitzel T. Hepatitis B Prevalence and Influence on HIV Treatment Outcome and Mortality in the Chilean AIDS Cohort. International Journal of Infectious Diseases 2013; 17: 919-24. https://doi.org/10.1016/j.ijid.2013.05.009
  38. Rockstroh K. Influence of Viral Hepatitis on HIV Infection. Journal of Hepatology 2006; 44(2006): 25-7. https://doi.org/10.1016/j.jhep.2005.11.007
  39. Rajbhandari R, Jun T, Khalili H, Chung T, Ananthakrishnan N. HBV/HIV Co-infection is Associated with Poorer Outcomes in Hospitalized Patients with HBV or HIV. Journal Viral Hepatology 2016; 23(10): 820-9. https://doi.org/10.1111/jvh.12555
  40. Clausen N, Lundbo F, Benfield T. Hepatitis C Virus Infection in The Human Immunodeficiency Virus Infected Patient. World Journal Gastroenterology 2014; 20(34): 12132-43. https://doi.org/10.3748/wjg.v20.i34.12132
  41. National AIDS Trust (NAT). Hepatitis C and HIV Co-infection. England: New City Cloisters; 2012; 1-14

Last update:

No citation recorded.

Last update:

No citation recorded.