Life expectancy and disparities in survival among HIV-infected people receiving antiretroviral therapy: an observational cohort study in Kathmandu, Nepal
Introduction The advent of antiretroviral therapy (ART) has dramatically slowed down the progression of HIV. This study assesses the disparities in survival, life expectancy and determinants of survival among HIV-infected people receiving ART.Methods Using data from one of Nepal’s largest population...
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BMJ Publishing Group
2019-06-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/3/e001319.full |
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| author | Dharma N Bhatta Ruchi Adhikari Sushil Karki Arun K Koirala Sharada P Wasti |
| author_facet | Dharma N Bhatta Ruchi Adhikari Sushil Karki Arun K Koirala Sharada P Wasti |
| author_sort | Dharma N Bhatta |
| collection | DOAJ |
| description | Introduction The advent of antiretroviral therapy (ART) has dramatically slowed down the progression of HIV. This study assesses the disparities in survival, life expectancy and determinants of survival among HIV-infected people receiving ART.Methods Using data from one of Nepal’s largest population-based retrospective cohort studies (in Kathmandu, Nepal), we followed a total of 3191 HIV-infected people aged 15 years and older who received ART over the period of 2004–2015. We created abridged life tables with age-specific survival rates and life expectancy, stratified by sex, ethnicity, CD4 cell counts and the WHO-classified clinical stage at initiation of ART.Results HIV-infected people who initiated ART with a CD4 cell count of >200 cells/cm3 at 15 years had 27.4 (22.3 to 32.6) years of additional life. People at WHO-classified clinical stage I and 15 years of age who initiated ART had 23.1 (16.6 to 29.7) years of additional life. Life expectancy increased alongside the CD4 cell count and decreased as clinical stages progressed upward. The study cohort contributed 8484.8 person years, with an overall survival rate of 3.3 per 100 person years (95% CI 3.0 to 3.7).Conclusions There are disparities in survival among HIV-infected people in Nepal. The survival payback of ART is proven; however, late diagnosis or the health system as a whole will affect the control and treatment of the illness. This study offers evidence of the benefits of enrolling early in care in general and ART in particular. |
| format | Article |
| id | doaj-art-be6a5d1785d0432eb1023e296643372d |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-06-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-be6a5d1785d0432eb1023e296643372d2025-08-20T02:37:52ZengBMJ Publishing GroupBMJ Global Health2059-79082019-06-014310.1136/bmjgh-2018-001319Life expectancy and disparities in survival among HIV-infected people receiving antiretroviral therapy: an observational cohort study in Kathmandu, NepalDharma N Bhatta0Ruchi Adhikari1Sushil Karki2Arun K Koirala3Sharada P Wasti4San Francisco AIDS Foundation, San Francisco, California, USADepartment of Dentistry, Nepal Medical College Teaching Hospital, Kathmandu, NepalDepartment of Microbiology, Pokhara University, Nobel College, Kathmandu, NepalDepartment of Public Health, Pokhara University, Lekhnath, NepalDepartment of Maternal Health, Institute for Reproductive Health, Kathmandu, NepalIntroduction The advent of antiretroviral therapy (ART) has dramatically slowed down the progression of HIV. This study assesses the disparities in survival, life expectancy and determinants of survival among HIV-infected people receiving ART.Methods Using data from one of Nepal’s largest population-based retrospective cohort studies (in Kathmandu, Nepal), we followed a total of 3191 HIV-infected people aged 15 years and older who received ART over the period of 2004–2015. We created abridged life tables with age-specific survival rates and life expectancy, stratified by sex, ethnicity, CD4 cell counts and the WHO-classified clinical stage at initiation of ART.Results HIV-infected people who initiated ART with a CD4 cell count of >200 cells/cm3 at 15 years had 27.4 (22.3 to 32.6) years of additional life. People at WHO-classified clinical stage I and 15 years of age who initiated ART had 23.1 (16.6 to 29.7) years of additional life. Life expectancy increased alongside the CD4 cell count and decreased as clinical stages progressed upward. The study cohort contributed 8484.8 person years, with an overall survival rate of 3.3 per 100 person years (95% CI 3.0 to 3.7).Conclusions There are disparities in survival among HIV-infected people in Nepal. The survival payback of ART is proven; however, late diagnosis or the health system as a whole will affect the control and treatment of the illness. This study offers evidence of the benefits of enrolling early in care in general and ART in particular.https://gh.bmj.com/content/4/3/e001319.full |
| spellingShingle | Dharma N Bhatta Ruchi Adhikari Sushil Karki Arun K Koirala Sharada P Wasti Life expectancy and disparities in survival among HIV-infected people receiving antiretroviral therapy: an observational cohort study in Kathmandu, Nepal BMJ Global Health |
| title | Life expectancy and disparities in survival among HIV-infected people receiving antiretroviral therapy: an observational cohort study in Kathmandu, Nepal |
| title_full | Life expectancy and disparities in survival among HIV-infected people receiving antiretroviral therapy: an observational cohort study in Kathmandu, Nepal |
| title_fullStr | Life expectancy and disparities in survival among HIV-infected people receiving antiretroviral therapy: an observational cohort study in Kathmandu, Nepal |
| title_full_unstemmed | Life expectancy and disparities in survival among HIV-infected people receiving antiretroviral therapy: an observational cohort study in Kathmandu, Nepal |
| title_short | Life expectancy and disparities in survival among HIV-infected people receiving antiretroviral therapy: an observational cohort study in Kathmandu, Nepal |
| title_sort | life expectancy and disparities in survival among hiv infected people receiving antiretroviral therapy an observational cohort study in kathmandu nepal |
| url | https://gh.bmj.com/content/4/3/e001319.full |
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