Mortality and causes of death among HIV-infected individuals in the country of Georgia: 1989-2012.
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.
1 Infectious Diseases, AIDS and Clinical Immunology Research Center , Tbilisi, Georgia .
Nikoloz
N
Chkhartishvili
Lali
L
Sharvadze
Otar
O
Chokoshvili
Natalia
N
Bolokadze
Nino
N
Rukhadze
Russell R
RR
Kempker
Amiran
A
Gamkrelidze
Jack A
JA
DeHovitz
Carlos
C
Del Rio
Tengiz
T
Tsertsvadze
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D015658:HIV Infections / Q000401:mortality*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult