Factors Associated with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) Related Mortality at Dr. Sardjito Hospital in Indonesia.

Abstract

Background: By 2019, the human immunodeficiency virus (HIV) had infected approximately 3.8 million people in Southeast Asia and caused 120,000 deaths. In Indonesia, despite periodic fluctuations, the incidence of HIV/AIDS continues to rise annually. Although antiretroviral therapy (ART) has substantially extended the lives of people living with HIV/AIDS (PLWHA), various risk factors continue to influence treatment outcomes. This study aimed to identify the risk factors significantly associated with mortality among PLWHA undergoing ART therapy at RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia.

Methods: In a retrospective cohort design, we reviewed sociodemographic and clinical data of all adult PLWHA (aged ≥18 years) who initiated ARV therapy at RSUP Dr. Sardjito Hospital between January 2008 and December 2021. Patients with incomplete baseline data or those referred from other facilities were excluded. The final cohort was categorized into surviving and deceased groups. Univariate and multivariate logistic regression analyses were conducted to determine the factors linked to mortality, and survival probabilities were estimated using Kaplan-Meier curves.

Results: Out of 1,591 patients included in the study, 199 died during the follow-up period. Univariate analysis revealed that age over 45 years, tuberculosis status, low CD4+ count, occupation, and advanced clinical stage of HIV/AIDS were significantly associated with mortality. Multivariate analysis further demonstrated that low CD4+ count, employment status, and, most notably, advanced clinical stage (stages 3 and 4) were independent predictors of death. The survival probabilities at 1 and 5 years were 89% and 87%, respectively.

Conclusion: Occupation, CD4+ count, and clinical stage critically influence mortality in PLWHA on ART therapy, with advanced clinical stage being the most significant. Early diagnosis and prompt ART initiation are essential to enhance survival.