Predictors of All-Cause Mortality Among People With Human Immunodeficiency Virus (HIV) in a Prospective Cohort Study in East Africa and Nigeria

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 Afr...

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Published in:Clinical infectious diseases 2022-09, Vol.75 (4), p.657-664
Main Authors: Kibuuka, Hannah, Musingye, Ezra, Mwesigwa, Betty, Semwogerere, Michael, Iroezindu, Michael, Bahemana, Emmanuel, Maswai, Jonah, Owuoth, John, Esber, Allahna, Dear, Nicole, Crowell, Trevor A, Polyak, Christina S, Ake, Julie A
Format: Article
Language:English
Subjects:
Anti-HIV Agents - therapeutic use
Cohort Studies
Female
HIV
HIV Infections - diagnosis
Humans
Major
Male
Nigeria - epidemiology
Prospective Studies
Tanzania
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Summary: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 
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/ciab995