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. 2022 Sep 10;75(4):657-664.
doi: 10.1093/cid/ciab995.

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

Hannah Kibuuka  1 , Ezra Musingye  1 , Betty Mwesigwa  1 , Michael Semwogerere  1 , Michael Iroezindu  2   3 , Emmanuel Bahemana  2   4 , Jonah Maswai  2   5 , John Owuoth  6   7 , Allahna Esber  2   8 , Nicole Dear  2   8 , Trevor A Crowell  2   8 , Christina S Polyak  2   8 , Julie A Ake  2 ; AFRICOS Study Group
Collaborators, Affiliations

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

Hannah Kibuuka et al. Clin Infect Dis. .

Abstract

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.

Keywords: Africa South of the Sahara; HIV; acquired immunodeficiency syndrome; cause of death; mortality.

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Conflict of interest statement

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.

Figures

Figure 1.
Figure 1.
Observed mortality rate among PLWH during study follow-up. Mortality rates were computed by dividing the total number of deaths by the total number of person-years of follow-up and multiplying by 1000 to obtain rates per 1000 PY. Among PLWH, 118 deaths were observed with an overall mortality rate of 11.42/1000 PY (95% CI: 9.53–13.68). Mortality rate for PLWH gradually reduced from 19.74/1000 PY in 2013–2014 to 4.74/1000 PY in 2019–2020 (P < .001). Abbreviations: CI, confidence interval; PLWH, people living with HIV; PY, person-years.
Figure 2.
Figure 2.
Causes of death among PLWH. Cause of death was available for 54% (64/118) of PLWH. Only 8 autopsies were performed to identify cause of death. Most frequent causes of death included infection in 19/64 (29.7%) and malignancy in 18/64 (28.1%). A slightly higher proportion of deaths (53.1%) were from non-HIV related causes. Abbreviations: HIV, human immunodeficiency virus; PLWH, people living with HIV.
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References

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