Predictors of HIV Progression to AIDS and Mortality from AIDS and Non- AIDS Related: A Retrospective Cohort Study in Isfahan, Iran

Introduction: Few studies in Iran have explored the potential impact of factors influencing the survival time of patients with HIV and AIDS. Therefore, this study was designed to estimate the time from the HIV to AIDS progression and the time from the AIDS to the AIDS-related death and non-AIDS-related death. The prognostic factors influencing this process were also investigated. Methods: This retrospective cohort study was conducted in Isfahan province, from 2000 to 2014.The outcome was three categories: alive or lost to follow up, and death due to AIDS related, non-AIDS-related. Cox proportional hazard and competing risks Cox model was employed to evaluate the effects of prognostic variables on the survival rate of progression to AIDS and from the AIDS to the AIDS-related death and non-AIDS-related death. Results: We identified 307 patients, 44 were ineligible. At the end of the study period, 197 (74.9%) patients were alive or lost to follow up, 28 (10.6%) died from AIDS-related causes, and 38 (14.4%) died from non-AIDS-related causes. Results showed there was a significant association between gender (P=0.04), increase in age (P=0.022), TB coinfection (P=0.004), and a decreased level of CD4 cell count (P=0.012) with progression to AIDS. Also there was a significant association between CD4 level (P=0.013) and antiretroviral therapy (P<0.001) and AIDS-related deaths. There was a significant association between a level of CD4 cell count (P=0.022) and TB coinfection (P=0.01) with non-AIDS-related deaths. Conclusion: A substantial proportion of the patients had progressed to AIDS in the first year because they were identified very late. This source of HIV infection had the chance to transmit the infection to others. Also patients who died from AIDS-related causes of death had poorer immunological status at recruitment.