All-cause mortality and associated factors among adults living with HIV receiving antiretroviral therapy in the Sughd region of Tajikistan: a retrospective cohort study, 2013–2022

Abstract Background Despite expanded access to antiretroviral therapy (ART), HIV-related mortality remains a concern in resource-limited settings. We assessed all-cause mortality and the factors associated with death among adults receiving ART in the Sughd region of Tajikistan. Methods We conducted a retrospective cohort study of adults (aged ≥ 18 years) diagnosed with HIV between 2013 and 2022 in the Sughd region who had received ART for ≥ 6 months. Data were obtained from the national electronic HIV case-tracking system. Mortality rates were calculated per 1,000 person-years (PY) and patients were followed from the date of diagnosis until death or censoring at the date of the last available clinical record or HIV viral load measurement. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for factors associated with all-cause mortality. Results Among the 1,871 individuals included, 57% were male, 38% had post-diagnosis migration, 11% had a history of injection drug use, 32% had advanced HIV disease at diagnosis (23% stage III; 9% stage IV). The median follow-up time was 4.2 years (interquartile range, 2.6–6.2 years). During follow-up, 163 individuals (9%) died, corresponding to a mortality rate of 19.5 per 1,000 PY. Mortality was high among those aged ≥ 50 years (50.0/1,000 PY), those with stage IV disease (60.2/1,000 PY), and those with tuberculosis (TB) history (63.5/1,000 PY). In the multivariable analysis, age 40–49 years (aHR = 1.9, 95%CI = 1.1–3.2) and ≥ 50 years (aHR = 4.6, 95% CI = 2.7–7.9) versus age 18–29 years, having employment status of “other” (students, retirees or those unable to work) versus unemployed (aHR = 2.1, 95% CI = 1.1–4.0), post-diagnosis migration (aHR = 2.0, 95%CI = 1.4–2.8), advanced HIV stage (stage III: aHR = 1.6, 95%CI = 1.0–2.6; stage IV: aHR = 2.8, 95%CI = 1.7–4.6 vs. stage I), viral load ≥ 1000 copies/mL (aHR = 6.2, 95%CI = 4.5–8.5), and TB history (aHR = 2.5, 95%CI = 1.7–3.7) were independently associated with mortality. Conclusion All-cause mortality among adults in Sughd who received ART remains high, and is associated with advanced HIV stage at diagnosis, unsuppressed viral load, post-diagnosis migration, TB history, “other” employment status, and older age. These findings may help inform strategies to improve HIV care and survival in similar settings.