Competing risks multi-state model for time-to-event data analysis of HIV/AIDS: A retrospective cohort national datasets, Ethiopia

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Abstract Introduction When HIV/AIDS patients die from opportunistic infections that cause death to happen more quickly, competing dangers are present. The objective of the current study was to estimate the probability of HIV/AIDS patients dying from competing illnesses such as tuberculosis, diarrhea, other opportunistic infections, and unidentified infections. Methods All regional states, including the administrative cities of Addis Abeba and Dire Dawa, a retrospective cohort research was carried out between November 2019 to March 2020. There were 39590 HIV-positive individuals considered. We used competing risk models with a time-to-death horizon of 1212 for the total number of HIV-positive people. A competing event was thought to be death from various causes. Results Out of the total 1212 deaths, 542(44.7%) died competing with other opportunistic infection (TE-Esophageal Candidiasis, TO-oral, CT-CNS Toxoplasmosis, CM-Crypotococcal Meningitis…), 421 (34.7%) died due to tuberculosis and the remaining death were unknown/Not specified infection 222(18.3%) and diarrhea 27(2.2%). Rates of mortality caused by tuberculosis, competing with other opportunistic infection, diarrhea and unknown/Not specified were 3.5, 4.5, 0.2 and 1.8 per 1000 person-months, respectively. Responding to combined Antiretroviral Treatment (cART) 6 months after initiation, receiving Pneumocystis Pneumonia (PCP) prophylaxis, and higher CD4 count at diagnosis reduced the hazard of tuberculosis, other opportunistic infection and unknown and diarrhea causes of death. However, older age, late HIV.AIDS diagnosis, and the last HIV/AIDS WHO clinical stages increased the hazard of tuberculosis and other opportunistic disease mortality. Additionally, male gender, older age and last HIV clinical stages increased the mortality HIV/AIDS patients. Conclusion The findings of this study demonstrated that TB, an opportunistic infection, was the primary cause of death in HIV/AIDS patients, despite the presence of several competing risks, such as diarrhea, other infections, and an undetermined or unclear cause. It’s important to use effective techniques to quickly detect those who have HIV or AIDS and provide them with care and treatment to increase their chances of surviving.

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