Risk factors associated with the deaths of people living with HIV in antiretroviral care sites in Bamako, Mali

Abstract

Introduction: Chronic Immunodeficiency Virus (HIV) infection, long-term antiretroviral therapy cancer diseases and the presence of co-infections have led to a diversification of morbidity and causes of death in people infected with HIV (PHA). HIV infection remains a major global public health issue, with nearly 33 million deaths. This study was conducted to study the risk factors associated with the deaths of people living with HIV (PHA) at antiretroviral treatment sites in Bamako, Mali. Methods and Materials: This was a cohort study that tracked people living with HIV at ten antiretroviral treatment sites in Bamako. The follow-up period for patients was twelve years (2006 to 2017). The PHA management sites selected from our study were community-based ARV treatment sites, University hospitals and integrated sites in referral health center Patients were monitored monthly during medical consultations and the provision of ARVs at the sites. The data were collected retrospectively through the national PHA monitoring tool called Evaluation and Monitoring of Operations of the Esther Project “ESOPE. The inclusion criteria were PHA over the age of 14 years, medical records, whether or not they were introduced to ARVs, and information on the national basis for monitoring PHAs. The The total number included was 48426 people living with HIV. The data was collected face-to-face during medical consultations by doctors. They were then transcribed into the individual patient tracking software “ESOPE”. The data tables (patients, follow-ups) were exported in Excel format for fusion and purification. The statistical analyses were carried out by STATA software version 14. Result: Female sex was more represented n= 32352, 66.81%, IC95% (66.38-67.22). The average age of participants was estimated at 39 years, IC95% (38.91-39.11). Patients living with HIV1 (n=44,623, 96.38%) were the majority represented in our study, In univariate analysis, participants who were initiated to ARVs and followed at our study sites were n=33,887, 70%, IC95% (69.56-70.38). People living with HIV over the age of 44 are at risk of dying 31% higher than those in the 15-44 age group (HR=1.31, IC95% (1.21-1.41), p-value=0.00). Non-initiated ART patients were 5% more likely to die than those initiated and followed by ARVs (HR= 1.05, IC95% (0.90-1.22), p-value=0.53). Mono HIV-infected patients had a lower risk of death 34% statically significant (HR=0.64 CI 95% (0.51-0.85), p=0.001) compared to co-infected TB/HIV patients. The univariate and multivariate analysis showed that patients who have a suppressed viral load at the first achievement after initiation to ARV treatment have a low risk of death than those who did not have a suppressed viral load. Patients at risk of malnutrition (risk of overweight and overweight) showed higher risk of dying (14% and 18%) respectively than those with normal body mass index (HR = 1.14 IC95% (0.86-1.50), p = 0.95) and (HR = 1.18 CI 95% (0.81-.170), p = 0.38). Conclusion: Risk factors associated with PHA deaths were female sex, high age, long-term ART, TB/HIV co-infection, malnutrition, and amount of viral load at initiation of ART.