Is tenofovir-based ART regimen challenging the survival of people living with HIV/AIDS attending a rural-based ART center of eastern India? A retrospective cohort study

Introduction: This research was conducted to assess the predictors for poor survival of patients living with human immunodeficiency virus (HIV) in a rural-based setting. Material and methods:In this retrospective cohort study, 92 HIV-positive individuals were selected by a simple random sampling method out of a total of 853 patients, who registered at the antiretroviral therapy (ART) clinic of Bankura Sammilani Medical College and Hospital before January 1, 2017.Selected participants were followed up until December 31, 2021, or until death, through reviewing secondary data, such as the ART enrolment register and the death register.Patients with incomplete data or who were transferred to other ART centers were excluded.Survival probability was expressed using life table and Kaplan-Meier plots.In bivariate analysis, statistically significant variables (p < 0.05) were considered for Cox regression model, from which, hazard ratio was assessed. Results:The overall HIV death incidence density rate from diagnosis until last observation was 2.65 per 100 person-years.In the last 5 years, the rate increased to 4.49 per 100 person-years.At the end of 5-year follow-up period, the cumulative survival probability was 79%.However, it is of concern that in the last year of follow-up, the survival probability drastically decreased from 90% to 79%.Patients who received TLE [tenofovir (TDF) + lamivudine (3TC) + efavirenz (EFV)] regimen for a maximum duration were found 2.83 times more vulnerable to death (hazard ratio = 2.830; 95% CI: 1.538-5.209%). Conclusions:Investigating the TLE regimen's risk assessment is crucial for patient safety and better health outcomes.