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Mortality among HIV-Infected Patients in Resource Limited Settings: A Case Controlled Analysis of Inpatients at a Community Care Center
Journal article   Open access

Mortality among HIV-Infected Patients in Resource Limited Settings: A Case Controlled Analysis of Inpatients at a Community Care Center

Nirmala Rajagopalan, Joyce Suchitra, Anita Shet, Zafar Khan, Julio Martin-Garcia, Michael Nonnemacher, Jeffrey Jacobson and Brian Wigdahl
American journal of infectious diseases, v 5(3), pp 219-224
01 Jan 2009
DOI: https://doi.org/10.3844/ajidsp.2009.219.224
PMID: 20204076
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.3844/ajidsp.2009.219.224View
Published, Version of Record (VoR)CC BY V4.0,  Open

Abstract

Infectious Diseases Life Sciences & Biomedicine Science & Technology
Problem statement: Despite massive national efforts to scale up Antiretroviral Therapy (ART) access in India since 2004, the AIDS death rate was 17.2 per 100,000 persons during 20032005. In the era of HAART in resource poor settings, it is imperative to understand and address the causes of AIDS related mortality. This collaborative study aimed at defining the predictors of mortality among people living with HIV/AIDS (PLHA) admitted during 2003-2005 to the Freedom Foundation (FF) Care and Support facility, Bangalore, India. Approach: Fifty consecutively selected HIV-infected patients who died during the study period and 50 HIV-infected patients matched by age, gender, route of transmission, nutrition status and stage of disease who survived at least 12 months post-ART were included in this study. The impact on mortality by factors such as: Hemoglobin, CD4+ T lymphocyte counts, weight loss and Opportunistic Infections (OIs) were studied. Statistical analyses were done by Chi-square, Fisher's Exact Test, Kaplan-Meier and multivariate logistic regression. Results: Recurrent diarrhea was a significant risk factor for mortality (OR = 12.25, p = 0.004), followed by a diagnosis of pulmonary tuberculosis (TB) at first admission (OR = 4.86) while TB in general also negatively impacted survival (p = 0.002). Though not statistically significant, Pneumocystis carinii pneumonia, Cryptococcal meningitis and Toxoplasmosis also negatively affected survival. Mortality was high among those not on HAART (81%) while it was significantly reduced (28%) among those on HAART (p<0.001). Patients who died had elevated liver enzymes (p = 0.027) and significant weight loss (p = 0.012). Mortality was high among patients irregular with their medical follow-up (p<0.001). Conclusion: Interventions that facilitate early OI diagnosis and treatment especially diarrhea and TB may reduce mortality in HIV. HAART alone without proper OI management and nutrition did not prevent mortality among PLHA. In resource poor settings, it becomes imperative to focus on low cost tools and increased capacity building along with regular clinical follow-up for diagnosis and early treatment of OIs. Further studies are warranted to explore benefits of initiating HAART earlier than currently recommended.

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Infectious Diseases
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