Factors Affecting Mortality in People Living with HIV with Antiretroviral Therapy: A Meta-Analysis
DOI:
https://doi.org/10.26911/jepublichealth.2024.09.04.08Abstract
Background: TB is the leading cause of death among people living with HIV. In 2020, an estimated 214,000 people living with HIV died from TB. People with AIDS have a severely damaged immune system. They are increasingly suffering from severe diseases, called opportunistic infections (OI). This study aims to analyze and estimate the influence of gender, TB Coinfection, Opportunistic Infection on mortality in ODHIV with Antiretroviral Therapy.
Subjects and Method: Systematic review and meta-analysis using PRISMA flowchart and the PICO model. Population: ODHIV with ART. Intervention: Women, Co-infected TB, Opportunistic Infections. Comparison: Male, no co-infected TB, no Opportunistic Infection. Outcome: Mortality Article search using Google Scholar, PubMed and Science Direct databases. The keywods used include "HAART" or "HIV" or "HIV/AIDS" and "Gender" and "TB Coinfections" or "TB" and "Opportunistic Infections" and "Mortality" and "Antiretroviral Treatment". The 17 included articles are fulltext in English with a cohort design study from 2008 to 2023 and report on the Hazard Ratio in a multivariate analysis. Data analysis using the RevMan 5.3 application.
Results: A total of 17 cohort studies involving 23,651 research subjects from Vietnam, China, Japan, Ethiopia, and South Africa. The data collected showed that female ODHIV had a mortality risk of 0.7 times compared to male ODHIV (aHR= 0.70; CI 95%=0.60 to 0.79; p<0.001). In ODHIV with coinfected TB has a mortality risk of 1.86 times compared to ODHIV without coinfected TB (aHR= 1.89; CI 95%=1.36 to 2.61; p<0.001). ODHIV with Opportunistic Infection has a 1.90-fold risk of mortality compared to ODHIV without Opportunistic Infection (aHR= 1.90; CI 95%=1.50 to 2.42; p<0.001).
Conclusion: Female gender decreases the risk of mortality, while TB coinfection and Opportunistic infection increase the risk of mortality in ODHIV with Antiretroviral Therapy.
Keywords:
HIV, ART, TB co-infection, opertunistic infection, mortalityCorrespondence
Fauziah Shinta Anindita. Master’s Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Jawa Tengah. Email: fauziahshinta789@gmail.com. Mobile: +6285291287786
References
Aemro A, Wassie M, Chekol B (2021). Incidence and predictors of mortality within the first year of antiretroviral therapy initiation at Debre-Markos Referral Hospital, Northwest Ethiopia: A retrospective follow-up study. Plos One. 16(5): 1–17. doi: 10.1371/journal.-pone.0251648
Andarge DE, Ewnetu H, Id H, Menna T (2022). Incidence, survival time and associated factors of virological failure among adult HIV / AIDS patients on first line antiretroviral therapy in St . Paul ’ s Hospital Millennium Medical College — A retrospective cohort study. Plos One. 17(10): 1-12. doi: 10.1371/journal.pone.0275204
CDCa (2021) AIDS and oportunistic infections. Centers for Disease Control and Prevention.
CDCb (2021). HIV affect Gay and bisexual men. Centers for Disease Control and Prevention
Chen Q, Liu J, Fu X, Yang F, Liu Q, Li J, Tan Z, et al. (2022). Effect of late testing and antiretroviral treatment on mortality among people living with HIV in the era of treat-all in Guangdong province, china, 1992–2018: a cohort study. Frontiers in Public Health, 10(7): 1–11. doi: 10.3389/fpubh.2022.851117
Cleveland (2024). Antiretroviral Therapy. AIDS Taskforce of Greater Cleveland
Cuong DODUY, Thorson A, Nnerborg ASÖ, Larsson M (2012). Survival and causes of death among HIV-infected patients starting antiretroviral therapy in north-eastern Vietnam. Scand J Infect Dis. 9: 201–208. doi: 10.3109/00365548.2011.631937
Damtew B, Mengistie B, Alemayehu T (2015). Survival and determinants of mortality in adult HIV/Aids patients initiating antiretroviral therapy in Somali Region, Eastern Ethiopia. Pan Afr Med J. 8688: 1–8. doi: 10.11604/pamj.2015.22.138.4352
Fekade D, Weldegebreal T, Teklu AM, Damen M, Baraki N, Belayhun B, Berhan E, et al. (2017). Predictors of survival among adult Ethiopian patients in the national ART program at Seven University Teaching Hospitals : A prospective cohort study. Ethiop J Health Sci. 27(si1): 63-71. doi: 10.4314/ejhs.v27i1.7S.
Girma D, Dejene H, Geleta LA,Tesema M, Bati F (2022). Time to occurrence, predictors, and patterns of opportunistic infections incidence among HIV-positive patients attending Antiretroviral Therapy Clinic of Salale University Comprehensive Specialized Hospital: A retrospective cohort study. Medicine. 9(1): 72. doi:10.1097/00019616-199901000-00020
Goletti D, Pisapia R, Fusco FM, Aiello A, Van Crevel R (2023). Epidemiology, pathogenesis, clinical presentation and management of TB in patients with HIV and diabetes. Jurnal Int Tuberc Lung Dis. 27(4): 284-290. doi: 10.5588/ijtld.22.0685
HIV.gov (2024). Opportunistic Infections. Minority HIV/AIDS Fund.
Ojikutu BO, Zheng H, Walensky RP, Lu Z, Losina E, Giddy J, Freeberg KA (2008). Predictors of mortality in patients initiating antiretroviral therapy in Durban, South Africa Afr Med J. 98 (3):204-8. PMID: 18350223; PMCID: PMC2408889.
Maskew M. Brennan AT, Westreich D, McNamara L, Macphail AP, & Fox MP. (2013). Gender Differences in Mortality and CD4 Count Response Among Virally Suppressed HIV-Positive Patients. J Womens Health. 22(2): 113-120. doi:10.1089/jwh.2012.3585
Murti B (2023). Penilaian Kritis (Critical Appraisal) Studi Kohor untuk Penelitian Meta-Analisis. Universitas Sebelas Maret
Nigussie F, Alamer A, Mengistu Z, Tachbele E (2020). Survival and predictors of mortality among adult HIV / AIDS patients initiating highly active Anti-retroviral Therapy in Debre-Berhan Referral Hospital, Amhara, Ethiopia: A retrospective study. HIV/AIDS – (Auckl). (12): 757–768. doi: 10.2147/HIV.S274747
Nishijima T, Inaba Y, Kawasaki Y, Tsukada K, Teruya K, Kikuchi Y, Gatanaga H, et al (2020). Mortality and causes of death in people living with HIV in the era of combination antiretroviral therapy compared with the general population in Japan. Jour Aids, 34(6): 913–921.doi:10.1097/QAD.0000000000002498
Niu D, Xiao T, Chen Y, Tang H, Chen F, Cai C, Qin Q, et al (2023). Excess mortality and associated factors among people living with HIV initiating highly active antiretroviral therapy in Luzhou, China 2006–2020. Bmc Infect Dis. 23(1): 1–10. doi: 10.1186/s12879-023-08165-4
Nyasulu PS, Ngasama E, Tamuzi JL, Sigwa-dhi LN, Ozougwu LU, Nhandara RBC, Ayele BT, et al. (2022). Effect of HIV status and antiretroviral treatment on treatment outcomes of tuberculosis patients in a rural primary healthcare clinic in South Africa. PloS One. 17(10). E0274549. doi: 10.1371/journal.pone.0274549
Setegn T, Takele A, Gizaw T, Nigatu D, Haile D (2015). Predictors of Mortality among Adult Antiretroviral Therapy Users in Southeastern Ethiopia: Retrospective Cohort Study. AIDS Res Treat. 1-8. doi: 10.1155/2015/148769
Seyoum D, Degryse J, Kifle YG, Taye A (2017). Risk Factors for Mortality among Adult HIV / AIDS Patients Following Antiretroviral Therapy in Southwestern Ethiopia : An Assessment through Survival Models. Int J Environ Res Public Health. 14: 1–12. doi:10.3390/ijerph14030296
Shapiro AE, Variava E, Rakgokong M, Moodle N, Luke B, Salimi S, Chaisson RE, et al. (2012). Community-based targeted case finding for tuberculosis and HIV in household contacts of patients with tuberculosis in South Africa. J Am Respir Crit Care Med. 185(10). 1110-1116.doi: 10.1164%2Frccm.20111-1-1941OC
Siraj M, Gedamu S (2022). Predictors of Survival Time Among HIV-Infected Adults After Initiating Anti-Retroviral Therapy in Kombolcha Town : A 5-Year Retrospective Cohort Study. HIV/AIDS-(Auckl). 4: 181–194.
Sutini R, Saefurohim MZ, Al Ayubi M, Wijayanti H, Wandastuti AD, Miarso D, Susilawati MS. (2022). Prevalence and Determinants of Opportunistic Infections in HIV Patients: A Cross-Sectional Study in the City of Semarang. Ethiopian J Health Sci. 32(4), 809–816. doi: 10.4314/ejhs.v32i4.18
Tachbele E, Ameni G (2016). Survival and predictors of mortality among human immunodeficiency virus patients on anti-retroviral treatment at Jinka Hospital, South Omo, Ethiopia : a six years retrospective cohort study. Epid and Health, 38: 1-10. doi: 10.4178/epih.e2016049110.
Tadesse K, Haile F, Hiruy N (2014). Predictors of Mortality among Patients Enrolled on Antiretroviral Therapy in Aksum Hospital, Northern Ethiopia : A Retrospective Cohort Study. Plos One, 9(1): 1-6. doi: 10.1371/journal.pone.0087392
Teshale AB, Tsegaye AT, Wolde HF (2021). Incidence of mortality and its predictors among hiv positive adults on antiretroviral therapy in University of gondar comprehensive specialized Hospital, northwest Ethiopia. HIV/ AIDS – (Auckl). 13: 31–39. doi: 10.2147/HIV.S289794
UNAIDS (2023) Global HIV & AIDS statistics — Fact sheet. UNAIDS (Joint United Nations Programme on HIV/AIDS)
UNAIDS (2022) Tuberculosis and HIV. UNAIDS (Joint United Nations Programme on HIV/AIDS).
WHO. (2022). Tuberkulosis. World Health Organization
WHO. (2023). HIV and AIDS. World Health Organization
Woldegeorgis BZ, Zekarias Z, Adem BG, Obsa MS, Kerbo AA. (2023). Prevalence and determinants of opportunistic infections among HIV-infected adults receiving antiretroviral therapy in Ethiopia: A systematic review and meta-analysis. Med Front. 10. doi: 10.3389/fmed.2023.1087086
Wondifraw EB, Chanie ES, Gebreeyesus FA, Biset G, Tefera BD, Zeleke M. (2022). Incidence and predictors of common opportunistic infection among HIV -infected children attending antiretroviral treatment clinic at Northeast Ethiopia, public hospitals 2022: A multicenter retrospective follow-up study. Annals Med Surgery. 84(2). doi: 10.1016/j.amsu.2022.104910.
Downloads
Published
2024-10-16
Issue
Vol. 9 No. 4 (2024)
Section
Articles