<p>Factors Affecting Survival Rates Among Adult TB/HIV Co-Infected Patients in Mizan Tepi University Teaching Hospital, South West Ethiopia</p>

Abstract

Background: Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection was responsible for approximately 300,000 deaths worldwide in 2017. Despite this burden of death, factors associated with the survival of TB-HIV co-infected patients were not adequately studied; and some of the existing evidences are inconsistent. This study was aimed to identify factors associated with survival rates of TB/HIV co-infected patients. Methods: The current study was a retrospective analysis of data extracted from 364 TB/HIV co-infected patients treated at Mizan Tepi University Teaching Hospital, Ethiopia, during the years 2007-2017. Time to event was measured from the date of TB treatment initiation till death, loss to follow-up or completion of treatment. Since the event was death, patients lost from follow-up and those on follow-up were considered as censored. Using Cox-regression, the 95% CI of hazard ratio (HR) and P-value <0.05 were used to identify the significant variables in multivariable analysis. Results: All the 364 patients were followed up for 1654 person-months. There were 83 (22.8%) deaths and the majority, 38 (45.8%), were occurring within the first two months of anti-TB treatment initiation. The overall incidence rate and median survival time were 5.02 per 100 person-months (95% CI: 4.05, 6.22) and 10 months, respectively. Not using CPT (adjusted hazard ratio [AHR] =1.72; P=0.023), bedridden functional status (AHR=2.55; P=0.007), not disclosing HIV status (AHR=4.03; P<0.001) and CD4 < 200 cells/mm 3 (AHR=6.05; P<0.001) were factors associated with survival rates of TB/HIV co-infected patients. Conclusion: Our finding signals that care and attention should be given to the victims of these synergistic diseases. There is room to improve the survival of the patients if those with low CD4 count and bedridden functional status are closely monitored; and if CPT is promptly initiated with encouraging HIV status disclosure.

A survival analysis of prognostic determinant factors of time-to-death of HIV/TB co-infected patients under HAART followed-up in a public hospital in Ethiopia

“…But, in the present study, the lognormal AFT model was the best fit for the data. The followup period of this study also revealed that there were 29.5% deaths among HIV/TB co-infected patients, which might be comparable with a study of Sanzana [17] and higher and lower than studies of [18][19][20][21][22][23] and [1,16,[24][25][26], respectively. In this study, female patients presented slightly higher survival time than male patients as indicated in the K-M plot of patients, which might show a comparable result with studies of Sanzana [17] and Kosgei et al [27].…”

Survival rate and predictors of mortality among TB/HIV co-infected adult patients: retrospective cohort study

“…This suggests that pharmacological interactions and overlapping toxicities of anti-TB and ART treatments, immunological reconstitution inflammatory syndrome, and other opportunistic infections, all of which have been linked to early death among TB/HIV co-infected patients, should be managed appropriately. In addition, our findings showed that the median time until death was found to be 17.6 months, which is longer than the previous study's finding which was 10 months reported from the Mizan-Tepi university teaching hospital 4 . Another multicenter study from southwest Ethiopia reported that the median time of death was 15.6 months, which is comparable to the results found in this study 24 .…”

“…A significant proportion of the deaths, 29 (34.5%), took place within the first five months of starting anti-TB medication. This is more than twice as high as the South African findings 32 , however, it is lower than the results from Mizan-Tepi University teaching hospital 4 . This suggests that pharmacological interactions and overlapping toxicities of anti-TB and ART treatments, immunological reconstitution inflammatory syndrome, and other opportunistic infections, all of which have been linked to early death among TB/HIV co-infected patients, should be managed appropriately.…”

“…Persons living with HIV have a 30-fold higher risk of developing TB compared to people who do not have the virus, and the risk of mortality among co-infected persons is nearly twice that of HIV-infected people alone 3 . In 2017, over 0.3 million people died worldwide due to TB and HIV co-infection 4 .…”

Survival and predictors of mortality after completion of TB treatment among people living with HIV

“…3 Moreover, most TB deaths occur during the first three months of TB treatment initiation. 4 Mortality during this period has been associated with low CD4 counts, not being on antiretroviral therapy (ART) 5, 6 and low body mass index (BMI) 4 at the time of TB diagnosis, Some studies in HIV negative patients indicate that even after successful completion of TB treatment, up to 59% of patients get lung impairment, 7 and consequently chronic lung disease. 8 Moreover, some observational studies have reported reduced long term survival in TB survivors in the United State, 9 and Vietnam.…”