Determinants of survival time among HIV-infected patients receiving care at antiretroviral therapy (art) clinic of a public hospital, Ethiopia

Abstract

Introduction: Even if there are different barriers to HIV testing in developing countries, timely access to care and early diagnosis improves the clinical course of the disease, reduces the transmission rates, and prolongs the survival time of patients. Objectives: This study aimed to investigate the potential predictors of survival time in a cohort of HIV-infected patients on ART using the parametric survival model perspective. Data and Methods: A hospital-based retrospective cohort charts-review study design was conducted on 647 patients from a public referral hospital in North-Central Ethiopia from July 2012 to January 2017. Log-rank and Wilcoxon tests, and an Accelerated Failure time (AFT) parametric statistical model were used. Results: A mean of 22.13months (SD=13.16) and a median of 21.47months (IQR: 11.55-33.30) were found. The median age, baselineCD4 count, and BMI of patients at baseline were 30years (IQR: 25-38years), 247cells/µl (IQR: 120-375cells/µl) and 19.75kg/m2 (IQR: 17.5-22kg/m2); respectively. At baseline, the patients CD4 count values ranged from 11 to 1764 (mean=289, SD= 233). The study revealed that 192(29.68%) events occurred, while 455(70.32%) were censored. The Gamma model was selected as the best-fit parametric model for the data. The estimated shape parameter of the fitted Gamma model is 1.9983 with 95%CI (1.3426, 2.9741) indicating that significantly determined as the survival time increases over time. Conclusion: The fitted AFT parametric model (Gamma distribution), the factors such as: higher BMI, higher current CD4 count, being married, starting on AZT-3TC-EFV regimen class significantly increased the survival time of HIV-positive patients attending ART treatment, while; baseline CD4 count and ambulatory functional status reduces the survival time of HIV patients. Moreover, using ART treatment significantly improves the survival time of patients.