Determinants of survival in adult HIV patients on antiretroviral therapy in Oromiyaa, Ethiopia

Figures & data

Table 1. Eligibility criteria for ART in adults and adolescents; adapted from the Ethiopian national ART guideline

CD4 count not available	CD4 count available
WHO clinical stage IV and III irrespective of total lymphocyte count (TLC)	WHO clinical stage IV, irrespective of CD4 count
WHO clinical stage II if TLC <1200/µL	WHO clinical stage III, if CD4 cell counts ≤350/µL
Do not treat WHO clinical stage I, in absence of CD4 count	All WHO clinical stages, if CD4 cell counts <200/µL

Note: TLC is only useful in deciding when to initiate ART in symptomatic patients with WHO clinical stage II disease. The use of CD4 cell count to guide treatment decision is advisable. For example, pulmonary TB may occur at any CD4 level and other conditions may be mimicked by non-HIV etiologies.

Fig. 1.  Inclusion of the study cohort for analysis.

Table 2. Socio-demographic characteristics of the study participants

Characteristics	Number (n=272)	Percentage
Total person years	410
Median duration of follow up (weeks)	104.4
Patients from hospitals
Assela	163	60.0
Shashemene	109	40.0
Median age (years)	33
Age in years
15–24	19	7.0
25–34	129	47.4
35–44	78	28.7
> 45	46	16.9
Sex
Women	155	57.0
Men	117	43.0
Marital status
Married	118	43.4
Never married	42	15.4
Divorced/separated	61	22.4
Widow/widower	51	18.4
Literacy status
Illiterate	51	18.8
Primary	124	45.6
≥ Secondary	97	35.7

Table 3. Clinical characteristics of the study participants on initiation of ART

Characteristics	Number (n=272)	Percentage
Baseline body weight (kg)
≤ 40	39	14.6
40–50	120	44.8
50–60	81	30.2
≥ 60	28	10.4
WHO clinical stage
Stage I	25	9.1
Stage II	54	20.0
Stage III	147	54.0
Stage IV	46	16.9
TB history a year before initiation of ART
Present	63	23.2
Absent	209	76.8
Criteria for initiation of ART
Clinically only	10	3.7
CD4 <200 cells/µL	223	82.0
CD4 ≥200 and stage III/IV	39	14.3
Original ART regimen
d4T + 3TC + NVP	98	36.0
d4T + 3TC + EFV	77	28.3
AZT + 3TC + NVP	54	19.9
AZT + 3TC + EFV	43	15.8
CPT initiation
Absent	31	11.4
Present	240	88.6
Hemoglobin (g/dL)
≤ 10	94	39.8
> 10	142	60.2
CD4 count at baseline (cells/µL)
≤ 50	54	20.2
51–200	173	64.8
> 200	40	15.0
Regimen change
Absent	32	12.0
Present	240	88.0

Fig. 2.  Kaplan–Meier survival curves according to: (a) CPT prophylaxis; (b) baseline hemoglobin; (c) clinical stage.

Table 4. Hazard ratios of mortality according to baseline variables in HIV patients starting ART in Ethiopia (real-case assumption)

	Univariate analysis		Multivariate analysis
Characteristics	Hazard ratio (95% CI)	p-Value	Hazard ratio (95% CI)	p-Value
Age (years)
15–24	1.00	0.74
25–34	0.78 (0.17–3.54)	0.73
35–44	1.30 (0.29–5.93)	0.75
≥ 45	1.30 (0.20––6.4)
Gender
Women	1.00	0.61
Men	1.22 (0.58–2.56)
Facility
Assela	1.00	0.60
Shashemene	1.22 (0.57–2.60)
Baseline weight (kg)
≤ 40	1.00	0.73
40–50	1.24 (0.36–4.30)	0.81
50–60	1.73 (0.32–4.32)	0.36
≥ 60	0.35 (0.36–3.33)
WHO clinical stage
Stage I/II	1.00		1.00
Stage III	1.29 (0.49–3.40)	0.60	2.02 (0.97–4.20)	0.60
Stage IV	0.65 (1.30–10.30)	0.01	5.13 (2.33–11.33)	0.00
Hemoglobin (g/dL)
≤ 10	1.00	0.011	1.00	0.03
> 10	0.35 (0.16–0.79)		0.39 (0.17–0.9)
CD4 count (cells/µL)
≤ 50	1.00	0.46
51–200	0.59 (0.15–2.4)	0.72
≥ 200	0.84 (0.33–2.13)
CPT initiation
Absent	1.00	0.00	1.00	0.00
Present	0.24 (0.11–0.54)		0.14 (0.05–0.37)

Table 5. Hazard ratios of mortality according to baseline variables in HIV patients starting ART in Ethiopia (worst-case assumption)

	Univariate analysis		Multivariate analysis
Characteristics	Hazard ratio (95% CI)	p-Value	Hazard ratio (95% CI)	p-Value
Age (years)
15–24	1.00	0.69
25–34	1.22 (0.48–3.07)	0.79
35–44	1.14 (0.43–3.02)	0.83
≥ 45	1.12 (0.40–3.13)
Gender
Women	1.00	0.10
Men	1.44 (0.93–2.24)
Facility
Assela	1.00	0.13
Shashemene	0.70 (0.44–1.11)
Baseline weight (kg)
≤ 40	1.00	0.06	1.00
40–50	0.58 (0.32–1.02)	0.02	0.91 (0.49–1.69)	0.75
50–60	0.47 (0.25–0.89)	0.01	0.55 (0.24–1.22)	0.14
≥ 60	0.25 (0.08–0.74)		0.26 (0.06–1.18)	0.08
WHO clinical stage
Stage I/II	1.00	0.04	1.00	0.25
Stage III	1.88 (1.01–3.5)	0.00	1.54 (0.73–3.25)	0.00
Stage IV	4.65 (2.38–9.12)		3.69 (1.60–8.47)
Hemoglobin (g/dL)
≤ 10	1.00	0.00	1.00	0.05
> 10	0.48 (0.29–0.78)		0.64 (0.38–1.08)
CD4 count (cells/µL)
≤ 50	1.00	0.19
51–200	0.70 (0.41–1.19)	0.47
≥ 200	0.77 (0.37–1.58)
CPT initiation
Absent	1.00	0.03	1.00	0.00
Present	0.55 (0.31–0.97)		0.38 (0.19–0.73)

Fig. 3.  Quartiles of 6 months follow up for (a) body weight and (b) CD4 count of patients.