Identifying spatial pattern, risk factors, and effect of trajectory of CD4 count for mortality among HIV-infected patients

Introduction: Identifying areas that the burden of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) disease is concentrated could play an important role in public health. The purpose of the present study was to assess pattern of spatial inequalities in survival in Hamadan Province, and to examine the effect of prognostic factors and trajectory of CD4 on the risk of mortality among HIV-infected patients.Material and methods: This registry-based cohort study was carried in Hamadan Province, Iran, from December 1997 to June 2020, and included 400 patients. Join modeling of longitudinal and spatially clustered survival data was used for analyzing data. Outcomes in longitudinal sub-model was the number of CD4 T-lymphocytes over time and time of HIV diagnosis, and outcomes in survival sub-model was time interval between HIV diagnosis and mortality.Results: According to our results, among all the predictors, there was only a significant relationship between co-infection with tuberculosis and CD4 trajectory. The association for risk of mortality was significant for antiretroviral therapy (ART) and co-infection with tuberculosis. Also, the lower CD4 counts during follow-up were related to a higher risk of mortality. Regarding mapping of our results for risk of mortality, we identified three counties with slightly higher hazards and three counties with rather lower hazards in Hamadan Province.Conclusions: The assessment of spatial pattern of HIV survival is helpful and appears to be dependent on socio-economic characteristics. Furthermore, our results suggest factors of access to ART and prevention of co-infection with tuberculosis, which may be useful to increase the length of patients' life.