Effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy at public hospitals of Eastern Ethiopia: A retrospective cohort study

Abstract

Background In resource-limited countries such as Ethiopia, tuberculosis is the major cause of morbidity and mortality among people living with the human immunodeficiency virus. In the era of antiretroviral therapy, the effect of tuberculosis on the survival of patients who are living with human immunodeficiency virus has been poorly understood in Ethiopia. Therefore, this study aimed to determine the effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy in public hospitals in Eastern Ethiopia. Methods An institution-based retrospective cohort study was conducted among 566 participants from January 1, 2014, to June 30, 2018. The collected data were entered into EpiData version 3.1 before being exported to Stata version 14 for analysis. A Cox proportional hazard model was used to determine the effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy, and a p-value less than 0.05 and a 95% confidence level were used to declare statistical significance. Result Of the 566 patients included in the study, 76 died. The mortality rate was 11.04 per 100 person-years in tuberculosis co-infected patients, while it was 2.52 per 100 person-years in non-tuberculosis co-infected patients. The patients with tuberculosis co-infection had a 2.19 times higher hazard of death (AHR: 2.19; 95% CI: 1.17, 4.12) compared to those without tuberculosis. Advanced clinical stage, low CD4+ cell count, and previous episodes of an opportunistic infection other than tuberculosis were found to be independent predictors of mortality. Conclusion Co-infection with tuberculosis at antiretroviral therapy initiation increases the hazard of death approximately two-fold. Hence, we recommend key organizations to enhance the region’s collaborative interventional and preventative strategies for TB and HIV.

Incidence rate of mortality and its predictors among tuberculosis and human immunodeficiency virus coinfected patients on antiretroviral therapy in Ethiopia: systematic review and meta-analysis

“…After screening 28 studies by title, abstract, and/or full text, 17 studies were removed because they did not meet inclusion criteria. From the electronic database searches, a total of 11 articles (12,(22)(23)(24)(25)(26)(29)(30)(31)(32)(33) were selected for SRMA. Second, in the website search, a total of 1,960 records were identified.…”

“…Then, in the website search, out of 13 studies (17, 22-24, 26, 27, 32-38), six of them were removed because of duplication with previous electronic database searches, and as a result, seven studies were selected. Finally, a total of 18 articles (12,17,(22)(23)(24)(25)(26)(27)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) with a total sample size of 26,291 TB/HIV-coinfected patients and non-TB cases as unexposed groups (two studies) were included in the SRMA study from both electronic databases and websites (Figure 1). methodological quality and risk of bias.…”

“…Despite the presence of effective HAART and TPT, the impact of TB on the mortality of PLHIV in Ethiopia was substantial (12,25,39,40). Therefore, this study aimed to determine the mortality rate and its predictors among TB/HIV-coinfected patients in Ethiopia using SRMA.…”

Active tuberculosis incidence among treatment failure experienced patients in North Wollow Zone: A multicenter historical cohort

“…Accounting for a 10% nonresponse rate due to incomplete medical records, the final sample size was determined as 445. However, between September 2016 and April 2020, there were a total of 493 HIV‐positive individuals 24 …”