Citation

Chkhartishvili N, Sharvadze L, Chokoshvili O, Bolokadze N, Rukhadze N, Kempker RR, Gamkrelidze A, Dehovitz JA, Del Rio C, Tsertsvadze T. AIDS Res. Hum. Retroviruses 2014; 30(6): 560-566.

Copyright

(Copyright © 2014, Mary Ann Liebert Publishers)

DOI

10.1089/aid.2013.0219

PMID

unavailable

Abstract

Since 2004, the country of Georgia has provided antiretroviral therapy (ART) to all patients in need. A nationwide retrospective cohort study was conducted to assess the effect of universal access to ART on patterns of mortality and causes of death among HIV-infected individuals in Georgia. All known HIV-infected adult individuals (age ≥18 years) diagnosed from 1989 through 2012 were included. Rates and causes of death were determined using routinely collected data from the national HIV/AIDS database. Causes of death were classified according to the Coding of Death in HIV (CoDe) protocol. Between 1989 and 2012, 3,554 HIV-infected adults were registered in Georgia contributing to 13,572 person-years (PY) of follow-up. A total of 779 deaths were registered during follow-up. The mortality rate peaked in 2004 with 10.74 deaths per 100 PY (95% CI: 7.92-14.24) and significantly decreased after the universal availability of ART to 4.02 per 100 PY (95% CI: 3.28-4.87) in 2012. In multivariate analysis the strongest predictor of mortality was having AIDS at the time of HIV diagnosis (hazard ratio: 5.69, 95% CI: 4.72-6.85). AIDS-related diseases accounted for the majority of deaths (n=426, 54.7%). Tuberculosis (TB) was the leading cause of death accounting for 21% of the total deaths reported. Universal access to ART significantly reduced mortality among HIV-infected patients in Georgia. However, overall mortality rates remain high primarily due to late diagnosis, and TB remains a significant cause of death. Improving rates of early HIV diagnosis and ART initiation may further decrease mortality as well as prevent new HIV and TB infections. © 2014 Mary Ann Liebert, Inc.

Language: en

Keywords

Humans; adolescent; Adult; Female; Male; adult; human; Adolescent; Cause of Death; suicide; female; male; accident; epidemiology; Retrospective Studies; Young Adult; ischemic heart disease; survival; Cohort Studies; cause of death; mortality; kidney failure; Survival Analysis; antiretroviral therapy; substance abuse; article; major clinical study; heterosexuality; retrospective study; Human immunodeficiency virus infection; priority journal; lung embolism; tuberculosis; HIV Infections; cerebrovascular accident; follow up; acquired immune deficiency syndrome; respiratory tract disease; cohort analysis; heart disease; digestive system disease; vascular disease; anti human immunodeficiency virus agent; gastrointestinal hemorrhage; central nervous system disease; virus hepatitis; CD4 lymphocyte count; wasting syndrome; Human immunodeficiency virus infected patient; virus antibody; AIDS related complex; young adult; antiviral therapy; hepatitis B surface antigen; cryptococcal meningitis; Georgia (republic); Georgia (Republic); end stage liver disease