Predictors of Survival Time Among HIV-Infected Adults After Initiating Anti-Retroviral Therapy in Kombolcha Town: A 5-Year Retrospective Cohort Study

Background: Antiretroviral therapy (ART) enhances the survival of HIV-infected patients by reducing viral load and increasing CD4. As CD4 count increases, patients are more protected against opportunistic infections. In developing countries including Ethiopia, there were limited studies about the survival benefit of ART particularly no study in Kombolcha Town. Thus, this study was aimed to address the gap.

Methods: A hospital-based retrospective cohort study was employed in Kombolcha town among 510 patients' records from January 2015 to December 2019. A systematic random sampling technique was used to select patient records. The collected data were checked, coded, and entered into Epidata version 4.6 and exported to Statistical Package for Social Sciences version 26 for data cleaning and analysis. Kaplan-Meier was used to estimate the probability of category of each predictor and a log rank test was used to compare survival curves. Bivariate and multivariate Cox-regression were employed using a 95% CI and variables with p-value <0.05 were declared as predictors of poor survival time.

Results: In this cohort, out of 510 HIV-infected patients, 39 (7.65%) were died, and 471 (92.35%) were censored. Fair drug adherence (AHR=6.88, 95% CI: 4.31-24.04), Poor drug adherence (AHR=9.58, 95% CI: 8.72-30.97), CD4 count <50 cell/µL (AHR=9.38, 95% CI: 1.48-59.31), CD4 count 50-99 cell/µL (AHR=9.67, 95% CI: 1.80-51.73), bedridden (AHR=9.5, 95% CI: 4.49-18.66), opportunistic infections (AHR=4.58, 95% CI: 1.20-5.65), weight <60kg (AHR=2.48, 95% CI:1.59, 10.38), WHO stage III (AHR=3.56, 95% CI: 1.71-17.89), WHO stage IV (AHR=4.42, 95% CI:1.75-25.93) were predictors of poor survival time.

Conclusion: The Kaplan-Meier result showed that the estimated median survival time of patients after ART initiation in Kombolcha town was higher (32 months) as compared to other studies. Poor drug adherence, WHO stage III & IV, Lower baseline CD4 count, presence of opportunistic infections, weight <60kg, and being bedridden were predictors of poor survival time. Thus, early initiation of ART ought to be encouraged among HIV-infected patients and good patient counseling on the level of adherence should be strengthened.