Survival and causes of death among HIV-infected patients starting antiretroviral therapy in north-eastern Vietnam

Abstract

Background: There is a lack of knowledge on mortality and causes of death among human immunodeficiency virus (HIV)-infected patients after initiation of antiretroviral therapy (ART) in Vietnam. We investigated the mortality rate, risk factors, causes of death, and impact of enhanced adherence support on survival among 640 Vietnamese treatment-naïve HIV-infected patients receiving ART in a cluster randomized controlled trial. Methods: Patients in the intervention group received enhanced adherence from peer-supporters. Data were collected through medical records and a verbal autopsy questionnaire. We used Kaplan–Meier analysis to describe the survival trends and the Cox proportional hazard model to identify predictors of acquired immune deficiency syndrome (AIDS)-related deaths. Results: After a median follow-up of 15.2 months, there were 60 deaths, 73% of which occurred within 6 months. The mortality rate was 7.4/100 person-y and survival probability was 91% after 1 y. There was no significant difference in mortality rate between the intervention and the control groups. At baseline, the predictive factors for AIDS-related death were age >35 y, clinical stage 3 or 4, body mass index (BMI) <18 kg/m², CD4 count <100/μl, haemoglobin level <100 g/l, and plasma viral load >100,000 copies/ml. Tuberculosis (TB) was the most common cause of death (40%). Conclusions: Early deaths occurred after ART, and delay of ART caused a significant decrease in CD4 count and a high mortality. Adherence support had no impact on survival at the early stage of ART. Early ART initiation and intensive follow-up of patients during the first 6 months of ART are therefore necessary to reduce AIDS-related mortality.

Keywords::

• Mortality
• causes of death
• ART
• peer support
• Vietnam

Acknowledgements

We would like to thank the Swedish International Development Cooperation Agency (SIDA); the Division of Global Heath (IHCAR), Karolinska Institutet; the Global Fund; CDC, LIFE-GAP Project; and the Health System Research Project of Hanoi Medical University, for providing financial and technical support. We are also grateful to Prof. Vinod Diwan, Prof. Pham Nhat An, Nguyen Binh Minh, Dr Tran Thanh Do, Dr Nguyen Phuong Thanh, the health staff, external supporters, and all patients in the DOTARV Project. Finally, many thanks to Dr Vu Minh Quan, Dr Luu Nguyen Hung, and Anastasia Pharris for providing valuable comments on this manuscript.

Declaration of interest: No conflict of interest.