Full Text Available
Note: Clicking the button above will open the full text document at the original institutional repository in a new window.
Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality
Background: Advanced HIV disease is the major contributor to the recent plateau in HIV related deaths globally. However, limited data exists on which patients with advanced HIV are at highest risk of death. Methods: A retrospective cohort study was nested within a larger cohort of 13 HIV treatment f...
Saved in:
| Main Author: | |
|---|---|
| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
Department of Public Health and Family Medicine
2023
|
| Subjects: | |
| Tags: |
No Tags, Be the first to tag this record!
|
| _version_ | 1867614223381561344 |
|---|---|
| access_status_str | Open Access |
| author | Fieggen, Joshua |
| author2 | Euvrard, Jonathan |
| author_browse | Euvrard, Jonathan Fieggen, Joshua |
| author_facet | Euvrard, Jonathan Fieggen, Joshua |
| author_sort | Fieggen, Joshua |
| collection | Thesis |
| description | Background: Advanced HIV disease is the major contributor to the recent plateau in HIV related deaths globally. However, limited data exists on which patients with advanced HIV are at highest risk of death. Methods: A retrospective cohort study was nested within a larger cohort of 13 HIV treatment facilities in Khayelitsha, South Africa. All adults who had a CD4 count less than 200 cells/mm3 between 1 January 2017 and 31 March 2021 were enrolled. Descriptive statistics were calculated, and the cohort was then restricted to those who had linked vital status information. We evaluated risk factors for mortality using risk ratios, Cox proportional hazards models and Kaplan-Meier curves. Results: Between 19% and 28% of the larger cohort (n=72,102) were estimated to have advanced HIV disease at any point during the study period. Of these patients 20% were on treatment, 40% were disengaged from care and 40% were treatment naïve at enumeration. Overall mortality was 12% with mortality highest in the first year (6,8%) following enumeration. Mortality was highest among patients on ART (17%) with viraemia an important risk factor for death in this group (aHR 1.42 [95% CI: 1.11 | 1.81]). Age >40 years, enumeration CD4 count, and tuberculosis were all predictors of death. 28% of patients off ART were found to have current tuberculosis at enumeration. Conclusion: There was a high prevalence of advanced HIV disease with significant associated mortality within this contemporary South African HIV cohort. Major modifiable contributors to mortality were disengagement from care and tuberculosis. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/37183 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:48:37.794Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2023 |
| publishDateRange | 2023 |
| publishDateSort | 2023 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/37183 Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality Fieggen, Joshua Euvrard, Jonathan Public Health Background: Advanced HIV disease is the major contributor to the recent plateau in HIV related deaths globally. However, limited data exists on which patients with advanced HIV are at highest risk of death. Methods: A retrospective cohort study was nested within a larger cohort of 13 HIV treatment facilities in Khayelitsha, South Africa. All adults who had a CD4 count less than 200 cells/mm3 between 1 January 2017 and 31 March 2021 were enrolled. Descriptive statistics were calculated, and the cohort was then restricted to those who had linked vital status information. We evaluated risk factors for mortality using risk ratios, Cox proportional hazards models and Kaplan-Meier curves. Results: Between 19% and 28% of the larger cohort (n=72,102) were estimated to have advanced HIV disease at any point during the study period. Of these patients 20% were on treatment, 40% were disengaged from care and 40% were treatment naïve at enumeration. Overall mortality was 12% with mortality highest in the first year (6,8%) following enumeration. Mortality was highest among patients on ART (17%) with viraemia an important risk factor for death in this group (aHR 1.42 [95% CI: 1.11 | 1.81]). Age >40 years, enumeration CD4 count, and tuberculosis were all predictors of death. 28% of patients off ART were found to have current tuberculosis at enumeration. Conclusion: There was a high prevalence of advanced HIV disease with significant associated mortality within this contemporary South African HIV cohort. Major modifiable contributors to mortality were disengagement from care and tuberculosis. 2023-03-03T09:37:44Z 2023-03-03T09:37:44Z 2022 2023-02-20T12:44:46Z Master Thesis Masters MPH http://hdl.handle.net/11427/37183 eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences |
| spellingShingle | Public Health Fieggen, Joshua Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality |
| thesis_degree_str | Master's |
| title | Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality |
| title_full | Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality |
| title_fullStr | Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality |
| title_full_unstemmed | Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality |
| title_short | Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality |
| title_sort | characteristics of a contemporary south african cohort of patients with advanced hiv disease and associated risk factors for mortality |
| topic | Public Health |
| url | http://hdl.handle.net/11427/37183 |
| work_keys_str_mv | AT fieggenjoshua characteristicsofacontemporarysouthafricancohortofpatientswithadvancedhivdiseaseandassociatedriskfactorsformortality |