Abstract

Globally, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) reduces life expectancy by seven years. Mortality is high among non-treated patients in Ethiopia with about 58.1/100 person years of observation. However, the predictors of mortality have not been adequately studied. Hence, the main objective of the study was to determine predictors of mortality among HIV positive adults on antiretroviral treatment in Debremarkos Referral Hospital, Northwest Ethiopia. A facility-based retrospective cohort study design was conducted from September to February, 2013. Data were collected from 640 patients who were enrolled for treatment in Debremarkos Referral Hospital from 2005 to 2013. Proportional hazards Cox model was used to show the independent predictors of the risk of mortality. A total of 261 patients died during the follow up period. Baseline hemoglobin level of < 10 g/mm³ (Adjusted Hazard Ratio (AHR) = 1.86, 95% CI: 1.39 to 2.64), baseline ambulatory functional status (AHR = 2.72, 95% CI: 1.90 to 3.90), bedridden functional status (AHR = 2.38, 95% CI: 1.32 to 4.27), baseline World Health Organization (WHO) staging III and IV (AHR = 2.16, 95% CI: 1.10 to 4.25), recent antiretroviral therapy (ART) adherence (AHR: 2.16, 95% CI: 1.03 to 4.56) and fair adherence (AHR = 1.88, 95%CI: 1.08-3.29) were associated with increased mortality. The risk rate of patients with unexplained chronic diarrhea and without prophylaxis for tuberculosis was increased by 1.53 and 3.98 times compared to patients without diarrhea and treated with tuberculosis prophylaxis, respectively. The mortality rate was high during early phase of treatment especially within the first 6 and 12 months. Baseline hemoglobin < 10 g/mm³, baseline functional status-ambulatory and bedridden functional status, baseline WHO staging (stage III and IV), poor recent antiretroviral therapy adherence, chronic diarrhea and absence of tuberculosis prophylaxis were all significant predictors of mortality. Therefore, patients with the aforementioned predictors should be followed closely and frequently.

Key words: Predictors, mortality, HIV positive adults, antiretroviral therapy, Ethiopia.