Factors associated with progression from HIV to death in patients receiving antiretroviral therapy in Southern Iran: a 21-year survival analysis and follow-up study

Abstract

Introduction: The expansion of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic has been considered a serious issue globally, and the disease is currently a major contributing factor to morbidity and mortality rates in many developing countries. This study aimed to investigate survival rate of HIV-positive patients, and its’ contributing factors among individuals receiving antiretroviral therapy in Southern Iran. Material and methods: A prospective cohort study was conducted among 1,327 HIV patients, who started antiretroviral therapy (ART) between June 2000 and March 2021. Kaplan-Meier analysis and Cox proportional hazard regression analyses were applied to define the survival rate of patients. Results: In this study, of 1,327 registered HIV/AIDS patients who were under ART, 30.6% died during the study period. The 1-, 2-, 5-, and 10-year survival rates of the patients were 90%, 87%, 78%, and 67%, respectively. Based on the results of multivariate Cox regression analysis, older age (HR≥40/<40 = 1.48), occupation (HRunemployment/employment = 1.29), history of addiction (ORyes/no = 1.64), route of transmission (HRIDU/sexual = 0.48), baseline CD4+ < 200 (HR< 200/>500 = 2.91), clinical stage IV (HRIV/I = 1.70), ART adherence (HRadherence/non-adherence = 0.37), time on ART > 5 (HR> 5/<1 = 0.06), and anemia (HRyes/no = 1.58) were directly associated with the survival in patients. Conclusions: Mortality in adults HIV-positive patients on antiretroviral therapy is relatively high in Iran. Age, history addiction, WHO clinical stage, low CD4+ count, and anemia are associated with poor survival in HIV patients. Concerned stakeholders should focus on early detection, timely ART onset, and adherence to treatment.