SSR Institute of International Journal of Life Sciences

ISSN (O): 2581-8740 | ISSN (P): 2581-8732

Sahoo et al., 2024
DOI: 10.21276/SSR-IIJLS.2024.10.1.25

Research Article

Exploring Causes of Mortality among HIV/AIDS Patients: A

Comprehensive Study at SLN Medical College and Hospital, Odisha
Hemanta Kumar Sahoo1, Chandan Kumar Gantayat2, Sangram Kishore Sabat3, Avijeet Swain4*
1
Assistant Professor, Department of Community Medicine, SLN Medical College & Hospital, Koraput, Odisha, India
2
Assistant Professor, Department of General Medicine, MKCG Medical College & Hospital, Berhampur, Odisha, India
3
Assistant Professor, Department of Orthopedics, MKCG Medical College & Hospital, Berhampur, Odisha, India
4
Assistant Professor, Department of Anaesthesiology, SCB Medical College & Hospital, Cuttack, Odisha, India

*Address for Correspondence: Dr Avijeet Swain, Assistant Professor, Department of Anaesthesiology, SCB Medical
College & Hospital, Cuttack, Odisha, India
E-mail: [email protected]

Received: 16 Aug 2023/ Revised: 13 Oct 2023/ Accepted: 13 Dec 2023

ABSTRACT
Background: The global impact of the AIDS pandemic is particularly pronounced in resource-poor tropical areas, where the
intersection of human immunodeficiency virus (HIV) infection and other tropical diseases, notably Tuberculosis (TB), presents a
significant challenge. This study focuses on the heightened morbidity, mortality, and social disruptions in Odisha, India, due to the
acquired immunodeficiency syndrome (AIDS) pandemic, necessitating an in-depth understanding of the complex dynamics of
causes of mortality in HIV/AIDS patients. This research specifically delves into the recent temporal trends in AIDS mortality.
Methods: This study was conducted at SLN Medical College and Hospital, Odisha, India. The study leverages medical records from
the Antiretroviral Therapy (ART) center. A standardized questionnaire documenting detailed information about circumstances
leading to mortality, was employed during regular follow-up assessments of 400 HIV/AIDS patients. The analysis involves both
descriptive and stratified approaches, with data stratification based on CD4 counts, a crucial parameter indicative of the immune
status of HIV/AIDS patients.
Results: The study analyzes 400 cases, revealing a diverse array of conditions contributing to mortality. TB emerges as a significant
threat, constituting 44.5% of reported deaths, emphasizing the persistent danger of TB to individuals with HIV/AIDS. The
distribution of causes of mortality is detailed in this study, highlighting the multifaceted nature of health challenges faced by this
vulnerable population.
Conclusion: The findings serve as a foundation for future research and interventions, contributing to improved strategies for
patient care and management in resource-constrained healthcare settings. Further insights into the distribution based on CD4
counts are presented, emphasizing the interplay between immunological status and disease susceptibility.

Key-words: HIV/AIDS, Tuberculosis, Causes of Mortality, CD4 counts, Resource-poor areas, Antiretroviral Therapy

INTRODUCTION
The global impact of the AIDS pandemic is particularly TB stands out as the most common opportunistic
pronounced in resource-poor areas in the tropics, where infection among individuals living with HIV/AIDS, and the
the intersection of HIV infection and other tropical bidirectional and synergistic interaction between HIV and
infectious diseases presents a significant challenge. TB accentuates the progression of both diseases [1,2].
In regions such as Odisha, India, the morbidity, mortality,
How to cite this article
Sahoo HK, Gantayat CK, Sabat SK, Swain A. Exploring Causes of and social disruptions caused by the AIDS pandemic are
Mortality Among HIV/AIDS Patients: A Comprehensive Study at heightened due to limited resources and healthcare
SLN Medical College and Hospital, Odisha. SSR Inst Int J Life Sci.,
infrastructure. Understanding the complex dynamics of
2024; 10(1): 3617-3623.
causes of mortality among HIV/AIDS patients in this
context becomes imperative. This study, conducted at
Access this article online
SLN Medical College and Hospital, Odisha seeks to
http://iijls.com/
comprehensively investigate and understand the factors

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 SSR Institute of International Journal of Life Sciences
ISSN (O): 2581-8740 | ISSN (P): 2581-8732
Sahoo et al., 2024
DOI: 10.21276/SSR-IIJLS.2024.10.1.25

contributing to mortality in this vulnerable population  Participants were HIV/AIDS patients receiving ART
[3,4]
. center therapy or follow-up.
Despite a decline in death rates due to AIDS in the  Only informed consent for medical record use and
United States and Western Europe following the study participation was obtained.
introduction of highly active antiretroviral therapy
(HAART), there is a growing number of deaths attributed Exclusion Criteria
to non-HIV-related or non-AIDS-related causes among  Patients who did not consent to the study and
patients with AIDS. The landscape of AIDS-related medical record use were excluded.
mortality is evolving, necessitating a closer examination  Incomplete or insufficient medical records that
to identify current trends and contributing factors [5,6]. prevented a full evaluation of the events and
The study aims to shed light on the recent temporal contributing factors before death were removed.
trends in AIDS mortality at a population level. The region,  Poor follow-up assessments that did not reveal
marked by its resource constraints, poses unique mortality causes were excluded.
challenges in managing the complex interplay of HIV and
Statistical analysis- Analysis of the collected data
co-infections, demanding a tailored understanding of the
involved both descriptive and stratified approaches.
causes of mortality.
Furthermore, the data were stratified based on CD4
MATERIALS AND METHODS counts, a critical parameter indicative of the immune
Research Design- The study was conducted at SLN status of HIV/AIDS patients. This stratification facilitated
Medical College and Hospital, Odisha, India from a nuanced understanding of how different causes of
September 2022 to August 2023. With the aim of death varied across different CD4 count categories. The
comprehensively investigating and understanding the robust methodology employed in this study ensures the
causes of mortality in HIV/AIDS patients. The research reliability and validity of the findings, offering valuable
leveraged the medical records maintained by the ART insights into the complex factors contributing to
center, which routinely documents the health status and mortality within the HIV/AIDS patient population.
outcomes of HIV/AIDS patients.
The causes of death were meticulously documented Ethical Approval- This study has been approved by the
using a standardized questionnaire during regular follow- Ethical Committee of the SLN Medical College & Hospital,
up assessments of HIV/AIDS patients. The questionnaire Koraput, Odisha, India.
aimed to capture detailed information about the
RESULTS
circumstances and contributing factors leading to
A total of 400 cases were meticulously analyzed to
mortality. The study included a total of 400 cases,
provide a detailed overview of the distribution of causes
ensuring a robust sample size for a comprehensive
of death, shedding light on the multifaceted nature of
analysis of causes of death in this vulnerable population.
health challenges faced by this vulnerable population.
The use of medical records and a structured
Table 1 elucidates the distribution of causes of mortality
questionnaire allowed for a systematic and detailed
in HIV/AIDS patients, showcasing both the frequency and
examination of each case, enabling the researchers to
percentage of cases attributed to each specific cause.
categorize the causes of mortality accurately. The study
The findings underscore the diversity of conditions
focused on capturing both the frequency and percentage
contributing to mortality, with bacterial pneumonia
distribution of specific causes of death, providing a
(6.25%), suicide (5.5%), TB (44.5%), and extrapulmonary
holistic overview of the health challenges faced by
tuberculosis (EPTB) (20.75%) emerging as prominent
HIV/AIDS patients at SLN Medical College and Hospital.
factors. Other notable contributors include hepatitis
Inclusion Criteria (7.75%), bacterial infections (4.5%), liver disease (3.75%),
 The study included participants who had regular accidents (2.25%), alcohol-related issues (2.25%),
follow-up exams at the ART facility to document diarrhea (1.75%), and cardiovascular diseases (0.75%)
their health status and outcomes. (Fig. 1).

Copyright © 2015–2024| SSR-IIJLS by Society for Scientific Research under a CC BY-NC 4.0 International License Volume 10 | Issue 01 | Page 3618
 SSR Institute of International Journal of Life Sciences
ISSN (O): 2581-8740 | ISSN (P): 2581-8732
Sahoo et al., 2024
DOI: 10.21276/SSR-IIJLS.2024.10.1.25

Table 1: Distribution of causes of mortality in HIV/AIDS patients

Mortality cause Number Percentage
Bacterial pneumonia 25 6.25
Suicide 22 5.5
TB 178 44.5
EPTB 83 20.75
Hepatitis 31 7.75
Bacterial infection 18 4.5
Liver disease 15 3.75
Accident 9 2.25
Alcohol related 9 2.25
Diarrhea 7 1.75
Cardiovascular disease 3 0.75
Total 400 100

Fig. 1: Distribution of causes of mortality

Delving deeper into the data, Table 2 provides insights patients with CD4 counts of 0-350 and 13.2% in those
into the distribution of causes of mortality based on CD4 with CD4 counts above 350. Similarly, EPTB exhibits a
counts, a crucial parameter indicative of the immune shift in prevalence, with 21.5% in the lower CD4 count
status of HIV/AIDS patients. This stratification allows for category and 21.1% in the higher CD4 count category.
a nuanced understanding of how different causes of These nuances highlight the importance of considering
death may vary across CD4 count categories. In Fig. 2, for immune status when analyzing causes of mortality in
instance, TB, a major contributor to mortality, shows a HIV/AIDS patients.
distinct distribution, with 45.6% of cases occurring in

Table 2: CD4 counts among the HIV/AIDS patients

CD4 counts
Cause of death Total
0-350 (n) 0-350 (%) 350-above (n) 350-above (%)
Bacterial 19 5.2 4 10.5 23
pneumonia
Suicide 19 5.2 5 13.2 24
TB 165 45.6 5 13.2 170

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 SSR Institute of International Journal of Life Sciences
ISSN (O): 2581-8740 | ISSN (P): 2581-8732
Sahoo et al., 2024
DOI: 10.21276/SSR-IIJLS.2024.10.1.25

EPTB 78 21.5 8 21.1 86

Hepatitis 25 6.9 5 13.2 30
Bacterial infection 16 4.4 1 2.6 17
Liver disease 11 3.0 3 7.9 14
Accident 9 2.5 1 2.6 10
Alcohol related 8 2.2 3 7.9 11
Diarrhea 8 2.2 0 0.0 8
Cardiovascular 4 1.1 3 7.9 7
disease
Total 362 100 38 100 400

Fig. 2: CD4 count distribution among HIV/AIDS patients

The results emphasize that TB remains a significant results [6]. Since 1995, high-HIV states have seen more
threat to the well-being of HIV/AIDS patients, comprising short-course tuberculosis therapy than low-HIV states.
nearly half of the reported deaths. The prevalence of However, HIV infection likely played a significant role in
specific causes across different CD4 count categories causing a significant lack of progress between 1990 and
indicates the complex interplay between immunological 2000 in the percentage of deaths from tuberculosis
status and the likelihood of succumbing to conditions. compared to total deaths in men aged 25-44 in urban
areas of states with high HIV prevalence. Furthermore, it
DISCUSSION
contributed to an increase in overall mortality among
This study provide valuable insights into the intricate
individuals aged 25-34 between 1997 and 2002. It led to
landscape of causes of mortality among HIV/AIDS
a higher number of deaths, specifically from tuberculosis
patients at SLN Medical College and Hospital, Odisha,
among men, in our mortality survey conducted from
India. The comprehensive analysis of 400 cases sheds
2001 to 2003 [7].
light on the multifaceted nature of health challenges
Our findings reveal a diverse array of conditions
faced by this vulnerable population.
contributing to mortality, with pulmonary tuberculosis
On the other hand, in 2004, India had an estimated
(TB), extrapulmonary tuberculosis (EPTB), hepatitis, and
100,000 deaths from HIV infection among adults aged
suicide standing out as notable factors. Pulmonary TB
15-59. In contrast to WHO's 2003 estimate of 270k
and EPTB are particularly significant contributors, with
deaths, our findings align with past indirect estimates of
44.5% of the reported deaths attributed to TB-related
mortality in India, and WHO's revised estimate of 127k
complications. This aligns with the broader literature,
HIV-related deaths in 2004 based on 2005/6 HIV survey

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 SSR Institute of International Journal of Life Sciences
ISSN (O): 2581-8740 | ISSN (P): 2581-8732
Sahoo et al., 2024
DOI: 10.21276/SSR-IIJLS.2024.10.1.25

emphasizing the persistent threat that TB poses to similar healthcare settings. The intricate factors
individuals living with HIV/AIDS [8-10]. contributing to mortality unveiled in our findings
Delving deeper into the data, the stratification based on underscore the need for ongoing efforts to address the
CD4 counts underscores the importance of considering healthcare needs of HIV/AIDS patients comprehensively.
immune status in understanding the distribution of In unraveling the complex tapestry of causes of mortality
causes of mortality. TB, a leading cause of death, exhibits among HIV/AIDS patients at SLN Medical College and
distinct patterns with higher prevalence in patients with Hospital, Odisha, India, this study provides crucial
CD4 counts of 0-350, emphasizing the interplay between insights into the multifaceted challenges faced by this
immunological status and disease susceptibility [11-14]. vulnerable population. The findings underscore the
Comparisons with previous studies offer valuable persistent threat of pulmonary tuberculosis (TB) and
contextualization. Our study aligns with the findings of extrapulmonary tuberculosis (EPTB), with TB-related
Charlotte et al. [3], highlighting AIDS-related illnesses as a complications comprising a substantial 44.5% of
substantial cause of mortality. The variations observed in reported deaths. This aligns with global patterns,
causes of death in different CD4 count categories emphasizing the ongoing menace that TB poses to
resonate with the temporal trends reported by Danforth individuals living with HIV/AIDS, especially in resource-
et al. [15]; Becker et al. [16]; Grover et al. [17]; Pati et al. [18], poor areas.
emphasizing the dynamic nature of HIV/AIDS-related Further in-depth analysis and interpretation of these
mortality. findings are warranted to unravel the intricate factors
The study contributes to the ongoing discourse on contributing to mortality within this population.
causes of death in HIV/AIDS patients, offering a local
CONTRIBUTION OF AUTHORS
perspective that aligns with global trends. The high
Research concept- Dr Chandan Kumar Gantayat
prevalence of TB-related deaths warrants targeted
interventions, including early diagnosis and appropriate Research design- Dr. Sangram Kishore Sabat
Supervision- Dr Avijeet Swain
management. The significant proportion of deaths due to
extrapulmonary manifestations underscores the need for Materials- Dr. Hemanta Kumar Sahoo
Data collection- Dr. Sangram Kishore Sabat
a comprehensive approach to tuberculosis control [19-21].
Data analysis and Interpretation- Dr. Hemanta Kumar
Our study also provides a foundation for future research
endeavors, calling for further in-depth analysis to unravel Sahoo
the intricate factors contributing to mortality within this Literature search- Dr Avijeet Swain
Writing article- Dr. Sangram Kishore Sabat
population. Drawing on insights from other studies, such
as Seyoum et al. [22]; Akhter et al. [23; Bates et al. [24], Critical review- Dr Avijeet Swain
Article editing- Dr Chandan Kumar Gantayat
which highlighted late-stage liver disease as a major
Final approval- Dr Avijeet Swain
cause of death, suggests that addressing comorbidities
remains a crucial aspect of HIV/AIDS patient care.
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