Mortality and associated factors among people living with HIV newly initiated into care at Bamenda Regional Hospital: A Retrospective Cohort Study

Introduction Globally and in Africa, HIV mortality is reported to have decreased over the years. Cameroon's national mortality rate was 1.7% in 2023, and there exist regional disparities and underreporting. We assessed the mortality and associated factors among People Living with HIV(PLHIV) initiated into HIV care from January 2021 to December 2023 at the Bamenda regional hospital (BRH) Methods A retrospective cohort study was conducted from June 2024 to December 2024 at the BRH. Using a non-probabilistic consecutive sampling technique, 331 newly initiated participants on ART were included. Data was collected from medical records using a questionnaire and analyzed using R software version 4.3.1. A multivariable Cox regression model included variables that showed statistical significance and assessed their relationship with mortality while adjusting for potential confounders. Significant predictors of mortality were identified. Results The mean age of participants was 41.6 {+/-} 11.7 years, and females constituted 57.7%. Opportunistic diseases were present in 19.0% of cases, with tuberculosis (8.2%) being the most common. Key comorbidities included hypertension (8.8%), diabetes (3.9%), and hepatitis B (3.0%). Blood tests showed elevated liver enzymes (ALAT/ASAT: 41.7{+/-}23.6 U/L) and high blood sugar (144.4{+/-}7.4 mg/dL). In contrast, kidney function (Creatinine: 0.9{+/-}0.2 mg/dL) and immune cell counts (Lymphocytes: 1.8{+/-}0.7 x103/L) appeared normal overall. A cumulative mortality rate of 7.6% over three years (approximately 2.5% per year) was observed. Male sex (AHR=7.83, 95% CI:1.44-42.5, p=0.017), opportunistic diseases (AHR=5.66, 95% CI:1.71-18.7, p=0.004), comorbidities (AHR=6.04, 95% CI:2.02-18.1, p=0.001), Abnormal ALAT/ASAT (p=0.005), and WHO clinical stage III (AHR: 1.1, 95%CI: 1.01 -1.5, p < 0.001), were identified as predictors of mortality. Whereas, BMI and ART adherence showed no significance. Conclusion Mortality among PLHIV in this study was associated with advanced disease, opportunistic diseases, commorbidities and abnormal laboratory findings. Strengthening early diagnosis, management of opportunistic infections, and monitoring of clinical and laboratory indicators may help reduce mortality in this population.