Predictors of Death Among HIV-Infected Adults Receiving Antiretroviral Therapy in Tanzania

Introduction: Mortality among HIV-infected individuals in sub-Saharan Africa, the region most affected by the HIV epidemic, has declined remarkably since the rapid scale-up of antiretroviral therapy (ART). Despite encouraging trends, an unacceptably high number of people in this region continue to die from HIV disease, accounting for nearly 70% of all HIV deaths globally. Although a substantial number of these deaths could be averted by further expansion of ART coverage, high rates of morality for those initiated on treatment threaten the success of large-scale ART coverage. A knowledge of the predicators of death among individuals on ART could lead to targeted interventions, thus reducing excess mortality. In this study, we investigated a cohort of HIV-infected individuals on ART in the Coping with HIV/AIDS in Tanzania (CHAT) to describe which predictors are associated with the outcome of death.

Methods: The Coping with HIV/AIDS in Tanzania (CHAT) study was an observational cohort study conducted between 2008 and 2012. A cohort of HIV-infected individuals on ART are analyzed by Kaplan-Meier models to estimate mortality and Cox proportional hazards to identify predictors of mortality.

Results: There were 25 deaths in 1775 person-years of follow-up. This overall mortality rate provides an incidence density of 1.4 deaths per 100 person-years. In univariate analysis, the factors associated with the predictor of mortality were male gender, secondary or higher education, and pre-ART CD4 count below 100 cells per milliliter. No such associations were found for age, marital status, asset score, underweight status, SF-8 physical health functioning, depressive symptoms, and perceived stigma. In multivariable analysis, significant predictors of mortality were gender, secondary or higher education, and pre-ART CD4 below 100 cells per milliliter.

Conclusion: A lower rate of mortality was detected among this cohort of HIV-infected individuals on ART in Tanzania. Male gender and pre-ART CD4 cell count below 100 cells per milliliter significant predictors of mortality. Interventions that target earlier engagement in care and improved outcomes for high risk groups such as men will lead to further optimization of HIV care.