Predictors of Mortality among Individuals with Tuberculosis and Human Immunodeficiency Virus Coinfection at a Reference Center in Southeastern Brazil: A Retrospective Cohort Study

Abstract

Background: Tuberculosis (TB) remains an important cause of morbidity, the leading cause of death in patients with human immunodeficiency virus (HIV) infection, and a challenge to global public health. This study aimed to analyze the predictors associated with mortality among individuals coinfected with TB/HIV at a reference center in southeastern Brazil. Method: This retrospective cohort study used the data obtained from clinical records and information systems from 2007 to 2014. The data were analyzed using Cox proportional hazards model to identify the independent predictors. Results: Among the 924 individuals studied, 72.7 % were men. The median age was 38 years (range: 16-78 years). The mortality rate was 21.6%. The predictors associated with mortality were as follows: age over 50 years (Adjusted Hazard Ratio [AHR] : 2.52, 95% confidence interval [CI]: 1.39-4.59), CD4+ T lymphocyte count ≤200 cells/mm3 [AHR]: 1.40, 95% [CI]: 0.86-2.27), detectable viral load [AHR]: 1.73, 95% [CI]: 0.98-3.01), and non-use of antiretroviral therapy [AHR]: 2.91, 95% [CI]: 1.71-4.93). Conclusion: Results demonstrated that patients coinfected with TB/HIV have high mortality rates. Therefore, it is necessary to address the social determinants of health to provide every individual an equal opportunity to gain access to healthcare to cope with TB/HIV coinfection.

Time to Death and Associated Factors among Tuberculosis Patients in South West Ethiopia: Application of Shared Frailty Model

“…Thus, a one year increase in the age of TB patients increased the risk of death by 2.2%. This result implies that the age of patients was directly associated with the mortality of TB patients [ 35 , 36 , 37 ]. Similarly, [ 38 ] showed that mortality due to TB was indirectly associated with increasing age.…”

Joint Modeling in Detecting Predictors of Cd4 Cell Count and Status of Tuberculosis Among HIV Infected Patients Under HAART at Felege Hiwot Teaching and Specialized Hospital, North-west Ethiopia

“…This might be due to the fact that in rural areas, the patients may faced with lack of balanced diet and proper adherence to medication because of limited accessibility of ART clinic settings or health facilities as compared to urban and low level of patients' awareness about the treatment. This indicates that the exposure of status of TB on HIV patients were high in rural area [22].…”

Tendência temporal da incidência da coinfecção TB/HIV e testagem de HIV da população idosa brasileira de 2008 a 2018

“…Similarly, a Chinese study found that not using ART was a risk factor for TB 31 . Other studies have shown that late-onset of ART 32 or not doing it 33 were risk factors for mortality in cases of coinfection.…”