Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality
| dc.contributor.advisor | Euvrard, Jonathan | |
| dc.contributor.author | Fieggen, Joshua | |
| dc.date.accessioned | 2023-03-03T09:37:44Z | |
| dc.date.available | 2023-03-03T09:37:44Z | |
| dc.date.issued | 2022 | |
| dc.date.updated | 2023-02-20T12:44:46Z | |
| dc.description.abstract | 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. | |
| dc.identifier.apacitation | Fieggen, J. (2022). <i>Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality</i>. (). ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/37183 | en_ZA |
| dc.identifier.chicagocitation | Fieggen, Joshua. <i>"Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality."</i> ., ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2022. http://hdl.handle.net/11427/37183 | en_ZA |
| dc.identifier.citation | Fieggen, J. 2022. Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality. . ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. http://hdl.handle.net/11427/37183 | en_ZA |
| dc.identifier.ris | TY - Master Thesis AU - Fieggen, Joshua AB - 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. DA - 2022_ DB - OpenUCT DP - University of Cape Town KW - Public Health LK - https://open.uct.ac.za PY - 2022 T1 - Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality TI - Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality UR - http://hdl.handle.net/11427/37183 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/37183 | |
| dc.identifier.vancouvercitation | Fieggen J. Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality. []. ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2022 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/37183 | en_ZA |
| dc.language.rfc3066 | eng | |
| dc.publisher.department | Department of Public Health and Family Medicine | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.subject | Public Health | |
| dc.title | Characteristics of a contemporary South African cohort of patients with advanced HIV disease and associated risk factors for mortality | |
| dc.type | Master Thesis | |
| dc.type.qualificationlevel | Masters | |
| dc.type.qualificationlevel | MPH |