Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality

Background: Advanced HIV disease is the major contributor to the recent plateau in HIV related deaths globally. However, limited data exists on which patients with advanced HIV are at highest risk of death. Methods: A retrospective cohort study was nested within a larger cohort of 13 HIV treatment facilities in Khayelitsha, South Africa. All adults who had a CD4 count less than 200 cells/mm3 between 1 January 2017 and 31 March 2021 were enrolled. Descriptive statistics were calculated, and the cohort was then restricted to those who had linked vital status information. We evaluated risk factors for mortality using risk ratios, Cox proportional hazards models and Kaplan-Meier curves. Results: Between 19% and 28% of the larger cohort (n=72,102) were estimated to have advanced HIV disease at any point during the study period. Of these patients 20% were on treatment, 40% were disengaged from care and 40% were treatment naïve at enumeration. Overall mortality was 12% with mortality highest in the first year (6,8%) following enumeration. Mortality was highest among patients on ART (17%) with viraemia an important risk factor for death in this group (aHR 1.42 [95% CI: 1.11 | 1.81]). Age >40 years, enumeration CD4 count, and tuberculosis were all predictors of death. 28% of patients off ART were found to have current tuberculosis at enumeration. Conclusion: There was a high prevalence of advanced HIV disease with significant associated mortality within this contemporary South African HIV cohort. Major modifiable contributors to mortality were disengagement from care and tuberculosis.

Grantor

Department of Public Health and Family Medicine

Year dc:date.issued

2022

Author dc:creator

• Fieggen, Joshua

Advisor dc:contributor.advisor

• Euvrard, Jonathan

• Public Health

Handle dc:identifier.uri

http://hdl.handle.net/11427/37183

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/37183