Factors Associated with Death during Tuberculosis Treatment of Patients Co-Infected with HIV at the Yaoundé Central Hospital, Cameroon: An 8-Year Hospital-Based Retrospective Cohort Study (2006–2013)

Abstract

BackgroundContributors to fatal outcomes in TB/HIV co-infected patients actively undergoing TB treatment are poorly characterized. The aim was to assess factors associated with death in TB/HIV co-infected patients during the initial 6 months of TB treatment.MethodsWe conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at the Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify hospitalized co-infected TB/HIV patients aged 15 years and older. Death was defined as any death occurring during TB treatment, as per the World Health Organization's recommendations. We conducted logistic regression analysis to identify factors associated with a fatal outcome. Magnitudes of associations were expressed by adjusted odds ratio (aOR) with 95% confidence interval.ResultsThe 337 patients enrolled had a mean age of 39.3 (standard deviation 10.3) years and 54.3% were female. TB treatment outcomes were distributed as follows: 205 (60.8%) treatment success, 99 (29.4%) deaths, 18 (5.3%) not evaluated, 14 (4.2%) lost to follow-up, and 1 (0.3%) failed. After exclusion of patients lost to follow-up and not evaluated, death in TB/HIV co-infected patients during TB treatment was associated with a TB diagnosis made before 2010 (aOR = 2.50 [1.31–4.78]; p = 0.006), the presence of other AIDS-defining diseases (aOR = 2.73 [1.27–5.86]; p = 0.010), non-AIDS comorbidities (aOR = 3.35 [1.37–8.21]; p = 0.008), not receiving cotrimoxazole prophylaxis (aOR = 3.61 [1.71–7.63]; p = 0.001), not receiving antiretroviral therapy (aOR = 2.45 [1.18–5.08]; p = 0.016), and CD4 cells count <50 cells/mm3 (aOR = 16.43 [1.05–258.04]; p = 0.047).ConclusionsThe TB treatment success rate among TB/HIV co-infected patients in our setting is low. Mortality was high among TB/HIV co-infected patients during TB treatment and is strongly associated with clinical and biological factors, highlighting the urgent need for specific interventions focused on enhancing patient outcomes.

Factors Associated with Mortality among Patients on TB Treatment in the Southern Region of Zimbabwe, 2013

“…Similar findings by Agbor et al [14] showed that those who were HIV coinfected and not receiving antiretroviral therapy were more than twofold likely to die. Among those HIV-infected, starting ART in the intensive phase of TB treatment was also associated with lower mortality compared to those who were previously on ART.…”

“…Being HIV-positive was the most common risk factor for mortality whilst on anti-TB treatment and this has been reported in studies from different parts of the world such as in Cameroon [14], the United States [15], South Africa [16], and Ghana [17]. HIV-positive individuals with latent TB are known to be approximately 20–30 times more likely to develop TB disease than those who are HIV negative, at a rate of 8–10% per year [1], because of their suppressed immune system which can result in an increase odds of mortality with further progression of the HIV disease killing 1 in 3 patients [18].…”

Does time to loss to follow-up differ among adult tuberculosis patients initiated on tuberculosis treatment and care between general hospital and health centers? A retrospective cohort study

“…The incidence of TB patient LTFU recorded at health centers was lower when compared to finding from Morocco [28]. However, it was higher when compared to studies conducted across different parts of the world which includes Ethiopia [1], Ukraine [29], Ethiopia [30,31], Dangila, Ethiopia [32], Cameroon [33], and South Africa [34]. The explanation for the variation could be explained from study setting and sample size.…”

Factors associated with mortality of TB/HIV co-infected patients in Ethiopia

“…(4) According to the national annual performance report of Ethiopia, 70% of TB patients with HIV were put on ART (5), but the mortality in TB/HIV co-infected patients remains high even after starting ART. Several factors have been identified that contribute to the high mortality rate, including low baseline CD4 count, having advanced disease at start of treatment and not receiving treatment(6). Most previous studies addressing TB related HIV deaths have focused only on assessing the relative contribution of TB to HIV related mortality.…”