Predictors of All-Cause Mortality Among People With Human Immunodeficiency Virus (HIV) in a Prospective Cohort Study in East Africa and Nigeria.
Africa South of the Sahara
HIV
acquired immunodeficiency syndrome
cause of death
mortality
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
10 09 2022
10 09 2022
Historique:
received:
21
07
2021
pubmed:
6
12
2021
medline:
14
9
2022
entrez:
5
12
2021
Statut:
ppublish
Résumé
Introduction of antiretroviral therapy (ART) has been associated with a decline in human immunodeficiency virus (HIV)-related mortality, although HIV remains a leading cause of death in sub-Saharan Africa. We describe all-cause mortality and its predictors in people living with HIV (PLWH) in the African Cohort Study (AFRICOS). AFRICOS enrolls participants with or without HIV at 12 sites in Kenya, Uganda, Tanzania, and Nigeria. Evaluations every 6 months include sociobehavioral questionnaires, medical history, physical examination, and laboratory tests. Mortality data are collected from medical records and survivor interviews. Multivariable Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for factors associated with mortality. From 2013 through 2020, 2724 PLWH completed at least 1 follow-up visit or experienced death. Of these 58.4% were females, 25.8% were aged ≥ 50 years, and 98.3% were ART-experienced. We observed 11.42 deaths per 1000 person-years (95% CI: 9.53-13.68) with causes ascertained in 54% of participants. Deaths were caused by malignancy (28.1%), infections (29.7%), and other non-HIV related conditions. Predictors of mortality included CD4 ≤ 350 cells/µL (aHR 2.01 [95% CI: 1.31-3.08]), a log10copies/mL increase of viral load (aHR 1.36 [95% CI: 1.22-1.51]), recent fever (aHR 1.85[95% CI: 1.22-2.81]), body mass index < 18.5 kg/m2 (aHR 2.20 [95% CI: 1.44-3.38]), clinical depression (aHR 2.42 [95% CI: 1.40-4.18]), World Health Organization (WHO) stage III (aHR 2.18 [95% CI: 1.31-3.61]), a g/dL increase in hemoglobin (aHR 0.79 [95% CI: .72-.85]), and every year on ART (aHR 0.67 [95% CI: .56-.81]). The mortality rate was low in this cohort of mostly virally suppressed PLWH. Patterns of deaths and identified predictors suggest multiple targets for interventions to reduce mortality.
Sections du résumé
BACKGROUND
Introduction of antiretroviral therapy (ART) has been associated with a decline in human immunodeficiency virus (HIV)-related mortality, although HIV remains a leading cause of death in sub-Saharan Africa. We describe all-cause mortality and its predictors in people living with HIV (PLWH) in the African Cohort Study (AFRICOS).
METHODS
AFRICOS enrolls participants with or without HIV at 12 sites in Kenya, Uganda, Tanzania, and Nigeria. Evaluations every 6 months include sociobehavioral questionnaires, medical history, physical examination, and laboratory tests. Mortality data are collected from medical records and survivor interviews. Multivariable Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for factors associated with mortality.
RESULTS
From 2013 through 2020, 2724 PLWH completed at least 1 follow-up visit or experienced death. Of these 58.4% were females, 25.8% were aged ≥ 50 years, and 98.3% were ART-experienced. We observed 11.42 deaths per 1000 person-years (95% CI: 9.53-13.68) with causes ascertained in 54% of participants. Deaths were caused by malignancy (28.1%), infections (29.7%), and other non-HIV related conditions. Predictors of mortality included CD4 ≤ 350 cells/µL (aHR 2.01 [95% CI: 1.31-3.08]), a log10copies/mL increase of viral load (aHR 1.36 [95% CI: 1.22-1.51]), recent fever (aHR 1.85[95% CI: 1.22-2.81]), body mass index < 18.5 kg/m2 (aHR 2.20 [95% CI: 1.44-3.38]), clinical depression (aHR 2.42 [95% CI: 1.40-4.18]), World Health Organization (WHO) stage III (aHR 2.18 [95% CI: 1.31-3.61]), a g/dL increase in hemoglobin (aHR 0.79 [95% CI: .72-.85]), and every year on ART (aHR 0.67 [95% CI: .56-.81]).
CONCLUSIONS
The mortality rate was low in this cohort of mostly virally suppressed PLWH. Patterns of deaths and identified predictors suggest multiple targets for interventions to reduce mortality.
Identifiants
pubmed: 34864933
pii: 6448919
doi: 10.1093/cid/ciab995
pmc: PMC9464064
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
657-664Investigateurs
Alexus Reynolds
(A)
Katherine Song
(K)
Mark Milazzo
(M)
Leilani Francisco
(L)
Steven Schech
(S)
Badryah Omar
(B)
Tsedal Mebrahtu
(T)
Elizabeth Lee
(E)
Kimberly Bohince
(K)
Ajay Parikh
(A)
Jaclyn Hern
(J)
Emma Duff
(E)
Kara Lombardi
(K)
Michelle Imbach
(M)
Leigh Anne Eller
(L)
Hannah Kibuuka
(H)
Michael Semwogerere
(M)
Prossy Naluyima
(P)
Godfrey Zziwa
(G)
Allan Tindikahwa
(A)
Claire Nakazzi Bagenda
(C)
Hilda Mutebe
(H)
Cate Kafeero
(C)
Enos Baghendaghe
(E)
William Lwebuge
(W)
Freddie Ssentogo
(F)
Hellen Birungi
(H)
Josephine Tegamanyi
(J)
Paul Wangiri
(P)
Christine Nabanoba
(C)
Phiona Namulondo
(P)
Richard Tumusiime
(R)
Ezra Musingye
(E)
Christina Nanteza
(C)
Joseph Wandege
(J)
Michael Waiswa
(M)
Evelyn Najjuma
(E)
Olive Maggaga
(O)
Isaac Kato Kenoly
(I)
Barbara Mukanza
(B)
Jonah Maswai
(J)
Rither Langat
(R)
Aaron Ngeno
(A)
Lucy Korir
(L)
Raphael Langat
(R)
Francis Opiyo
(F)
Alex Kasembeli
(A)
Christopher Ochieng
(C)
Japhet Towett
(J)
Jane Kimetto
(J)
Brighton Omondi
(B)
Mary Leelgo
(M)
Michael Obonyo
(M)
Linner Rotich
(L)
Enock Tonui
(E)
Ella Chelangat
(E)
Joan Kapkiai
(J)
Salome Wangare
(S)
Zeddy Bett Kesi
(Z)
Janet Ngeno
(J)
Edwin Langat
(E)
Kennedy Labosso
(K)
Joshua Rotich
(J)
Leonard Cheruiyot
(L)
Enock Changwony
(E)
Mike Bii
(M)
Ezekiel Chumba
(E)
Susan Ontango
(S)
Danson Gitonga
(D)
Samuel Kiprotich
(S)
Bornes Ngtech
(B)
Grace Engoke
(G)
Irene Metet
(I)
Alice Airo
(A)
Ignatius Kiptoo
(I)
John Owuoth
(J)
Valentine Sing'oei
(V)
Winne Rehema
(W)
Solomon Otieno
(S)
Celine Ogari
(C)
Elkanah Modi
(E)
Oscar Adimo
(O)
Charles Okwaro
(C)
Christine Lando
(C)
Margaret Onyango
(M)
Iddah Aoko
(I)
Kennedy Obambo
(K)
Joseph Meyo
(J)
George Suja
(G)
Michael Iroezindu
(M)
Yakubu Adamu
(Y)
Nnamdi Azuakola
(N)
Mfreke Asuquo
(M)
Abdulwasiu Bolaji Tiamiyu
(A)
Afoke Kokogho
(A)
Samirah Sani Mohammed
(S)
Ifeanyi Okoye
(I)
Sunday Odeyemi
(S)
Aminu Suleiman
(A)
Lawrence C Umeji
(LC)
Onome Enas
(O)
Miriam Ayogu
(M)
Ijeoma Chigbu-Ukaegbu
(I)
Wilson Adai
(W)
Felicia Anayochukwu Odo
(F)
Rabi Abdu
(R)
Roseline Akiga
(R)
Helen Nwandu
(H)
Chisara Sylvestina Okolo
(C)
Ogundele Taiwo
(O)
Otene Oche Ben
(O)
Nicholas Innocent Eigege
(N)
Tony Ibrahim Musa
(T)
Juliet Chibuzor Joseph
(J)
Ndubuisi C Okeke
(NC)
Zahra Parker
(Z)
Nkechinyere Elizabeth Harrison
(N)
Uzoamaka Concilia Agbaim
(U)
Olutunde Ademola Adegbite
(O)
Ugochukwu Linus Asogwa
(U)
Adewale Adelakun
(A)
Chioma Ekeocha
(C)
Victoria Idi
(V)
Rachel Eluwa
(R)
Jumoke Titilayo Nwalozie
(J)
Igiri Faith
(I)
Blessing Irekpitan Wilson
(B)
Jacinta Elemere
(J)
Nkiru Nnadi
(N)
Francis Falaju Idowu
(F)
Ndubuisi Rosemary
(N)
Amaka Natalie Uzeogwu
(A)
Theresa Owanza Obende
(T)
Ifeoma Lauretta Obilor
(I)
Doris Emekaili
(D)
Edward Akinwale
(E)
Inalegwu Ochai
(I)
Lucas Maganga
(L)
Emmanuel Bahemana
(E)
Samoel Khamadi
(S)
John Njegite
(J)
Connie Lueer
(C)
Abisai Kisinda
(A)
Jaquiline Mwamwaja
(J)
Faraja Mbwayu
(F)
Gloria David
(G)
Mtasi Mwaipopo
(M)
Reginald Gervas
(R)
Dorothy Mkondoo
(D)
Nancy Somi
(N)
Paschal Kiliba
(P)
Ephrasia Mwalongo
(E)
Gwamaka Mwaisanga
(G)
Johnisius Msigwa
(J)
Hawa Mfumbulwa
(H)
Peter Edwin
(P)
Willyhelmina Olomi
(W)
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.
Déclaration de conflit d'intérêts
Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.
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