Abstract:

Background: Advanced HIV disease (AHD) is a persistent problem in SSA in the setting of the test and treat and starting cART regardless of the CD4 cell count on presentation. Studies done in rural Tanzania highlight a high mortality rate of people with AHD with one person in five deaths in six months and the majority of these deaths occurring during the first month of follow-up. Opportunistic infections and diseases that are associated with AIDS are primarily responsible for HIV/AIDS morbidity and mortality.

Objective: This study aimed to determine the prevalence of AHD, one-month mortality, and associated factors among newly diagnosed HIV-positive patients in Mwanza City.

Methods: This was an analytical cross-sectional study with longitudinal follow-up. A total of 159 participants were analyzed. Data analysis was performed using Stata version 15. Logistic regression was used to determine the association of mortality as an outcome of interest among study participants. The Cox regression model was conducted to assess the hazard ratios among study participants.
Results: More than half (73.0%) of the participants were aged between 35 and 75. Their median (IQR) was 40 (33-49). The overall prevalence of AHD was 22%. The mortality rate was 82 per 1000 person per month. The mortality among AHD patients were significantly associated with CD4 count less than 100 cells/ml (aOR=1.22, 95%CI=1.08, 1.87; p<0.001), WHO clinical stage 3 or 4 (aOR=1.87, 95%CI=1.42, 2.52; p<0.001), definitive pulmonary TB (aOR=2.35, 95%CI=1.16,4.78; p<0.001),definitive severe bacterial infection (aOR=1.46, 95%CI=1.05, 3.38; p=0.02), definitive CNS toxoplasmosis (aOR=1.23, 95%CI=1.07, 4.08; p<0.001), definitive recurrent severe bacterial pneumonia (aOR=1.99, 95%CI=1.23, 4.33; p<0.001), hepatitis B (aOR=2.67, 95%CI=1.35,5.25; p<0.001), definitive extra-pulmonary TB (aOR=1.79, 95%CI=1.38, 7.79; p<0.001), Cryptococcal infection (aOR=1.85, 95%CI=1.37, 2.49; p<0.001) and Cryptococcal meningitis (aOR=1.65, 95%CI=1.21, 3.45; p=0.003). Advanced HIV disease patients with CD4 count <100 cells/ml and WHO stage 3 or 4 had higher mortality rates and therefore a poor survival prognosis.

Conclusion: The prevalence of AHD among newly diagnosed HIV-positive in Mwanza city is very high. Individuals with AHD were likely to present with more than one opportunistic infection. A high rate of mortality among patients with AHD was attributed to preventable diseases. Patients with CD4 count <100cell/ml and those with WHO stage 3 or 4 die significantly more compared to their counterparts. Therefore, the provision of a full AHD package cannot be overemphasized.