Risk Factors for Mortality among HIV-Positive Patients with and without Active Tuberculosis in Dar Es Salaam, Tanzania

Abstract

Background: The aim of this study was to describe risk factors for mortality and clinical characteristics of HIVinfected patients with and without tuberculosis (TB) coinfection. Methods: A cohort of HIV-infected patients with CD4 + T-cell counts of ≤200 cells/ml was recruited, consisting of 255 HIV-infected patients without active TB and 231 patients with active TB. All received a well-supervised treatment with an efavirenz-based HAART, and those coinfected with TB received appropriate anti-TB treatment. They were followed up for 48 weeks after HAART initiation. Results: Common presenting symptoms in HIV-only patients were fever (36.5%), headache (34.5%), skin rash (34.5%) and weight loss (32%), while in HIV-TB patients the symptoms were weight loss (58%), cough (57.6%), night sweats (44.6%) and fever (34.2%). HIV-TB patients had significantly lower body mass index, Karnofsky scores and haemoglobin levels compared to those infected with HIV only, despite similar baseline CD4 + T-cell counts. Overall, 12 (4.7%) HIV patients developed TB and 7 (3%) HIV-TB patients had worsening of their TB symptoms during the study period. Mortality was similar in the two groups, being 10.9% (16 deaths per 100 person years) and 11.3% (17 deaths per 100 person years) in HIV-only and HIV-TB patients, respectively. Overall, more males (13.1%) died compared to females (9.6%). Predictors of mortality were presence of oral candidiasis, Kaposi's sarcoma, low Karnofsky score, and low baseline white blood cell and CD4 + T-cell counts. Conclusions: The outcomes following well-supervised treatment of HIV-TB patients are similar to those in patients with HIV alone. Predictors of mortality were those of advanced disease.

Prevalence and Risk Factors of Mortality among Adult HIV Patients Initiating ART in Rural Setting of HIV Care and Treatment Services in North Western Tanzania: A Retrospective Cohort Study

“…The mortality rate among HIV patients receiving ART in the index study is similar to prevalence of 11.7% reported from Senegal in 2006 [17]. But it is as well similar to that reported previously from Dar es Salaam by Mugusi et al in 2012 [18]. In this study, the prevalence of death was 10.9% and 11.3% among those with HIV alone and among those with TB coinfection, respectively, suggesting that mortality on receipt of ART is still a common phenomenon among HIV patients attending both rural and urban settings of HIV care and treatment services in Tanzania.…”

Importance of Ethnicity, CYP2B6 and ABCB1 Genotype for Efavirenz Pharmacokinetics and Treatment Outcomes: A Parallel-Group Prospective Cohort Study in Two Sub-Saharan Africa Populations

“…In brief, higher efavirenz plasma concentration and CYP2B6*6 genotype were associated with efavirenz based HAART induced liver enzyme abnormality. Most deaths were associated with advanced HIV disease and the risk factors were oral candidiasis and Kaposi’s sarcoma [26]. No mortality due to suicide was observed.…”

“…In contrast among Ethiopian study participants, we noticed that neuropsychiatric symptoms were less common and none of the patients discontinued their treatment due to CNS related problems. The safety profile and associated risk factors particularly with respect to drug induced liver enzyme abnormality and mortality from the same cohort is published recently [19], [21], [26]. In brief, higher efavirenz plasma concentration and CYP2B6*6 genotype were associated with efavirenz based HAART induced liver enzyme abnormality.…”

The Effect of Tuberculosis Treatment at Combination Antiretroviral Therapy Initiation on Subsequent Mortality: A Systematic Review and Meta-Analysis

“…Of these, 119 full-text articles were selected for review. In total, 20 articles [2,26-44] and three conference abstracts [45-47] were eligible. Four additional articles met our inclusion criteria: two from reference lists [48,49] and two from Web of Science citation searches [50,51].…”

“…All were cohort studies. Most publications assessed mortality after cART initiation, regardless of regimen type, though some reported estimates specific to nevirapine-[31,41,48,49] or efavirenz-based [26,31,37] therapy. See Table S1 for cART regimens used by each study.…”