Aug 2026· World Journal of Advanced Research and Reviews· 0 citations
TL;DR
Mortality among PLHIV in this study was associated with advanced disease, opportunistic diseases, commorbidities and abnormal laboratory findings, and Strengthening early diagnosis, management of opportunistic infections, and monitoring of clinical and laboratory indicators may help reduce mortality in this population.
Abstract
Introduction: Globally and in Africa, HIV mortality is reported to have decreased over the years. Cameroon's national mortality rate was 1.7% in 2023, and there exist regional disparities and underreporting. We assessed the mortality and associated factors among People Living with HIV(PLHIV) initiated into HIV care from January 2021 to December 2023 at the Bamenda regional hospital (BRH)
Methods: A retrospective cohort study was conducted from June 2024 to December 2024 at the BRH. Using a non-probabilistic consecutive sampling technique, 331 newly initiated participants on ART were included. Data was collected from medical records using a questionnaire and analyzed using R software version 4.3.1. A multivariable Cox regression model included variables that showed statistical significance and assessed their relationship with mortality while adjusting for potential confounders. Significant predictors of mortality were identified.
Results: The mean age of participants was 41.6 ± 11.7 years, and females constituted 57.7%. Opportunistic diseases were present in 19.0% of cases, with tuberculosis (8.2%) being the most common. Key comorbidities included hypertension (8.8%), diabetes (3.9%), and hepatitis B (3.0%). Blood tests showed elevated liver enzymes (ALAT/ASAT: 41.7±23.6 U/L) and high blood sugar (144.4±7.4 mg/dL). In contrast, kidney function (Creatinine: 0.9±0.2 mg/dL) and immune cell counts (Lymphocytes: 1.8±0.7 x10³/μL) appeared normal overall. A cumulative mortality rate of 7.6% over three years (approximately 2.5% per year) was observed. Male sex (AHR=7.83, 95% CI :1.44-42.5, p=0.017), opportunistic diseases (AHR=5.66, 95% CI :1.71-18.7, p=0.004), comorbidities (AHR=6.04, 95% CI :2.02-18.1, p=0.001), Abnormal ALAT/ASAT (p=0.005), and WHO clinical stage III (AHR : 1.1, 95%CI : 1.01 -1.5, p < 0.001), were identified as predictors of mortality. Whereas BMI and ART adherence showed no significance.
Conclusion: Mortality among PLHIV in this study was associated with advanced disease, opportunistic diseases, commorbidities and abnormal laboratory findings. Strengthening early diagnosis, management of opportunistic infections, and monitoring of clinical and laboratory indicators may help reduce mortality in this population.
Antiretroviral therapy (ART) has significantly improved outcomes for people living with HIV (PLHIV) globally. However, loss to follow-up (LTFU) remains a major barrier to the effectiveness of ART programs, particularly in resource-limited settings. In Ethiopia, LTFU contributes substantially to patient attrition, yet data from high-burden zones like Guji remain limited. Therefore, this study aimed to determine the incidence rate and identify predictors of loss to follow-up among HIV-infected adults receiving ART at public health facilities in Guji zone, Southern Ethiopia, 2023. An institution-based retrospective cohort study was conducted among 434 HIV-positive adults who initiated ART between July 2018 and June 2022 at public health facilities in Guji zone. Participants were selected using simple random sampling. Data were extracted from medical records using a structured checklist and entered into Epi Data 4.6.2. Analysis was performed using SPSS 25 and STATA 14. The incidence rate of LTFU (defined as >30 days since last scheduled appointment date and has not been classified as “dead” or “transferring out) was calculated per 100 person-years. Bivariable and multivariable Cox proportional hazards regression were used to identify predictors of LTFU. Adjusted hazard ratios (AHR) with 95% confidence intervals and p-values < 0.05 were considered statistically significant. Among 434 participants (60% female) followed for 904.35 person-years, 135 (31.1%) were lost to follow-up, yielding an incidence rate of 14.93 per 100 person-years. Factors significantly associated with higher LTFU risk were: male sex (AHR = 1.85, 95%CI: 1.27–2.69), age 15–30 years (AHR = 2.40, 95%CI: 1.58–3.64), female sex work (AHR = 3.26, 95%CI: 1.39–7.65), daily labor/mobile work (AHR = 1.91, 95%CI: 1.16–3.16), and no formal education (AHR = 2.20, 95%CI: 1.52–3.20). Protective factors associated with lower LTFU risk were: residing in the same woreda as the health facility (AHR = 0.55, 95%CI: 0.38–0.82) and having a documented phone number (AHR = 0.46, 95%CI: 0.31–0.67). The incidence of LTFU among adults on ART in Guji zone was high, particularly during the first year of treatment. Male sex, younger age, lack of formal education, female sex work, and daily labor were associated with increased LTFU risk, while residing in the same woreda as the health facility and having documented phone numbers were protective. Targeted interventions including enhanced counseling for high-risk groups, community-based ART refill models, and active phone-based tracking systems should be implemented to improve retention.
Summary Background Advanced HIV disease (AHD) remains a major cause of hospitalization and mortality among people living with HIV (PLHIV). We evaluated the association between implementation of a structured specialist-led inpatient HIV care model and clinical outcomes among hospitalized PLHIV in southern Brazil. Methods We conducted an observational before–after study at a tertiary public hospital in Porto Alegre, Brazil, comparing a pre-intervention period (January 2023–April 2024) with a post-intervention period (May 2024–August 2025). The intervention included a dedicated infectious diseases team, standardized protocols for AHD and opportunistic infections, and rapid antiretroviral therapy (ART) initiation during hospitalization. Adults admitted with AHD were included. Adjusted risk ratios (aRR) for mortality, ICU admission, and a composite adverse outcome were estimated using modified Poisson regression. Findings A total of 963 hospitalizations among 899 unique patients were included (406 pre-intervention; 557 post-intervention). Baseline characteristics were similar between periods. In-hospital mortality declined from 24% to 17% (p = 0.014). In adjusted analyses, the post-intervention period was associated with lower risks of in-hospital mortality (aRR 0.74, 95% CI 0.57–0.96), ICU admission (0.70, 0.57–0.86), and composite adverse outcomes (0.78, 0.67–0.92). Opportunistic infection screening increased, lumbar puncture was performed more frequently, and ART was initiated earlier. Interpretation Implementation of a structured inpatient HIV care model was associated with improved clinical outcomes among PLHIV with AHD. Structured multidisciplinary inpatient HIV care may represent a promising approach to strengthen delivery of WHO-recommended AHD care in hospital settings and warrants further evaluation in controlled studies. Funding Pan American Health Organization (PAHO), US Centers for Disease Control and Prevention (CDC), and Unitaid.
P. M. Fonseca, Andressa Noal, Gisele O. Boff et al.· The Lancet Regional Health -...· 0 citations
Background Dyslipidemia is a common metabolic complication among people living with HIV and a major contributor to cardiovascular morbidity and mortality. However, it remains insufficiently characterized in Ethiopia, particularly in contemporary urban ART settings. Methods We conducted a facility‐based cross‐sectional study among 398 patients selected by systematic random sampling from November 1 to December 31, 2025. Data were collected using a structured data collection tool, entered into KoboToolbox, and analyzed in SPSS Version 27. Bivariable and multivariable logistic regression analyses were used to identify factors associated with dyslipidemia. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and p < 0.05 was considered statistically significant. Results The median age of participants was 50 years (IQR: 42–56), and 66.8% (n = 266) were female. The median duration since HIV diagnosis was 19 years (IQR: 15–20). Predominant regimens included TDF+3TC+ DTG (72.8%). The prevalence of dyslipidemia was 65.3% (95% CI: 60.5–70.1), with elevated triglycerides (37.2%), total cholesterol (34.7%), high LDL‐C (34.2%), and low HDL‐C (28.1%). On multivariable analysis, dyslipidemia was significantly associated with history of ART change (AOR 2.62, 95% CI: 1.13–6.04), hypertension (AOR 2.45, 95% CI: 1.28–4.69), overweight (AOR 3.56, 95% CI: 1.44–8.81), obesity (AOR 5.15, 95% CI: 1.16–22.82), and sedentary and moderate physical activity (AOR 9.46, 95% CI: 2.46–36.32 and AOR 3.80, 95% CI: 1.77–8.18, respectively). Conclusion Dyslipidemia was prevalent among approximately two in three HIV‐positive patients receiving long‐term ART at two tertiary hospitals in Addis Ababa, Ethiopia. These findings highlight the need for routine lipid monitoring and integrated cardiovascular risk management within HIV care settings in similar urban, tertiary‐care contexts.
Nebiat Adane, Mekoya Mengistu, Tariku Fekadu et al.· AIDS Research and Treatment· 0 citations
Background Tuberculosis is a major communicable disease and the leading cause of death among people living with HIV/AIDS, accounting for nearly 40% of AIDS-related deaths. This study assessed the incidence and predictors of tuberculosis among adults receiving antiretroviral therapy in Central Gondar Zone, Northwest Ethiopia, from December 2016 to January 2022. Methods A multicenter retrospective follow-up study was conducted among 488 adult HIV-positive individuals on antiretroviral therapy. Data were collected using an Android-based mobile application and analyzed using a Cox proportional hazards model. Variables with p < 0.05 were considered significant predictors. Results The tuberculosis incidence rate was 2.87 per 100 person-years (95% CI: 2.22–3.70). Increased risk was associated with opportunistic infections (Adjusted Hazard Ratio (AHR)=3.16), poor antiretroviral therapy (ART) adherence (Adjusted Hazard Ratio (AHR)=3.53), and family size ≥5 (AHR=2.36). Isoniazid preventive therapy (IPT) reduced tuberculosis risk (AHR≈0.26–0.29). Conclusion Tuberculosis incidence was relatively low. Poor adherence, opportunistic infections, and large family size increased risk, while isoniazid use was protective.
Wabiw Addis, Adugnaw Zeleke, S. Nigatu et al.· Journal of the International...· 0 citations
Background: The proportion of obesity is increasing among PLHIV worldwide. As Indians are genetically prone for obesity and its complications. The objectives were to determine the prevalence of generalised and abdominal obesity and assess its risk factors among PLHIV on ART.
Methods: This Cross-sectional analytical study was conducted at an ART Centre, tertiary care hospital from February to April 2023. 496 study subjects were recruited. Data was collected using pre-tested standardized, semi-structured questionnaire. Results were expressed in both descriptive and inferential statistics using Stata 14.
Results: Among 496 subjects, majority 51.5% were females. More number of subjects, 45.3% were in the age group of 40-50 years and 71.4% were married. Greater number of study subjects belonged to upper socioeconomic class, i.e. 68.3%. The burden of generalized & abdominal obesity was 64.5% & 75.4% respectively. Significant association of generalized obesity was observed with CD4 count. Significant association of abdominal obesity was observed with sex, marital status and CD4 count.
Conclusions: More than two third of the PLHIV had abdominal obesity and more than three fifth had generalized obesity. High CD4 count was the risk factor for generalized obesity and female sex, being married and high CD4 count were risk factors for abdominal obesity among PLHIV.
Ramesh Masthi NR, Pruthvi S, Lavanya R et al.· National Journal of Communit...· 0 citations
The Democratic Republic of Congo (DRC) is among the sub-Saharan African countries with a high neonatal mortality rate. Various interventions have been implemented to reduce this mortality rate, including the establishment of free maternity policy. This study evaluated the neonatal and maternal factors influencing infant mortality at 6 weeks of life. A prospective cohort study was conducted on infants recruited between March and July 2024 from maternity wards in Kinshasa, DRC. The cohort was followed for up to 6 weeks with home visits. The statistical analysis used Kaplan-Meier and adjusted Cox models. The multivariate Cox model was fitted with variables selected by LASSO and missing data were imputed using multiple imputation according to Rubin’s rules. Among a cohort of 2,383 infants followed, 3.2% had a low-5 minutes Apgar score and 96.8% had a normal Apgar score. One of five babies with low 5-minutes Apgar scores died by the age of six weeks. Overall, the early postnatal mortality was 2.2% (95% CI: 1.67-2.85) with an overall mortality incidence of 0.53 deaths per 1,000 person-days. Multivariate Cox regression analysis with multiple imputation identified statistically significant increases in the associations of early postnatal mortality risk for low-5 minutes Apgar score (aHR: 9.96; 95% CI: 7.01-14.17), low birth weight (aHR: 3.57; 95% CI: 2.39-4.72) and prematurity (aHR: 1.97% CI: 1.26-3.12). Conversely, antenatal visits were a protective factor, with each additional antenatal visit associated with a 19% reduction in the risk of infant mortality (aHR: 0.81; 95% CI: 0.66-0.99). These results underscore the crucial importance of high-quality obstetric and neonatal care, as well as antenatal monitoring, for improving newborn survival. They call for strengthened antenatal care, improved screening and management of at-risk newborns in healthcare facilities, and the integration of these indicators into strategies for reducing neonatal mortality in resource-limited settings.
F. Kabasubabo, H. Bezanahary, Julien Magne et al.· PLOS Global Public Health· 0 citations
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