ArticlePloS one2019
Predictors of mortality in adult people living with HIV on antiretroviral therapy in Nepal: A retrospective cohort study, 2004-2013.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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9 citing papers in PubMed.
- HIV-1 reverse transcriptase subtyping revealed CRF35-AD as a current subtype in the northeast of Iran.Molecular biology research communications · 2025Article
- Survival and predictors of mortality among HIV-infected adults after initiation of antiretroviral therapy in Eastern Ethiopia Governmental hospitals, from January 2015 to December 2021 (multi-center retrospective follow-up study).BMC infectious diseases · 2024Article
- Statistical analysis on the incidence and predictors of death among second-line ART patients in public hospitals of North Wollo and Waghemira Zones, Ethiopia, 2021.Scientific reports · 2024Article
- Survival trends among people living with human immunodeficiency virus on antiretroviral treatment in two rural districts in Ghana.PloS one · 2024Article
- Article
- A Prognostic Model to Assess Long-Term Survival of Patients on Antiretroviral Therapy: A 15-Year Retrospective Cohort Study in Southwestern China.Open forum infectious diseases · 2021Article
- Effect of the Test and Treat Strategy on Mortality Among HIV-Positive Adult Clients on Antiretroviral Treatment in Public Hospitals of Addis Ababa, Ethiopia.HIV/AIDS (Auckland, N.Z.) · 2021Article
- Article
- High HIV prevalence among decedents received by two high-volume mortuaries in Kisumu, western Kenya, 2019.PloS one · 2021Article
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4 authors.
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Abstract
backgroundIn Nepal, since 2004, 19,388 people living with HIV (PLHIV) have been enrolled on antiretroviral therapy (ART). The aim of this study was to measure mortality rate and to identify predictors of mortality in adult (≥15 years) PLHIV who initiated ART between 2004 and 2013 in five large ART centers of Nepal.
methodsThis retrospective cohort study of 3,799 (60.5% male) adult PLHIV uses secondary data collected from standard ART registers. Time from ART initiation (baseline) to death or censoring (loss to follow-up or December 31, 2013) was assessed. Mortality rates per 100 person-years were calculated. Kaplan-Meier models were used to estimate the probability of mortality over time. Predictors of mortality were determined using Cox-regression models.
resultsThe overall mortality rate was 6.98 (95% CI: 6.46-7.54) per 100 person-years, 4.11 (95% CI: 3.53-4.79) in females and 9.14 (95% CI: 8.36-9.99) in males. Mortality rates were higher in early months after ART initiation, particularly in the first three months. Baseline predictors of mortality were ART center, male gender (adjusted HR = 2.08, 95% CI: 1.69-2.57), residence outside the ART district (AHR = 1.45, 95% CI:1.19-1.76), World Health Organization clinical stage III (AHR = 1.67, 95% CI: 1.13-2.46) and IV (AHR = 2.21, 95% CI: 1.45-3.36), bedridden <50% time in the last month (AHR = 1.92, 95% CI: 1.52-2.41), bedridden >50% time in the last month (AHR = 3.82, 95% CI: 2.95-4.94), lower bodyweight/kg (AHR = 1.04, 95% CI: 1.03-1.05), CD4 count <150 cell/mm3 (AHR = 2.14, 95% CI: 1.05-4.34) and treatment not switched to second-line regimen (AHR = 3.05, 95% CI: 1.35-6.90).
conclusionsMortality rates were higher soon after ART initiation, particularly in males and gradually decreased over time. Poor baseline clinical characteristics were significantly associated with higher mortality. Increased ART coverage with decentralization of sites to lower levels including community dispensing, differentiated and improved service delivery and initiation of ART at a less advanced disease stage may reduce early mortality.
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