The Effect of Long-Term HAART on the Incidence of Tuberculosis Among People Living with HIV in Addis Ababa, Ethiopia: A Matched Nested Case–Control Study

Abstract

Background:The introduction of antiretroviral therapy (ART) significantly decreases the incidence of tuberculosis (TB) in people living with human immunodeficiency virus (PLWHIV). However, a considerable proportion is still co-infected with TB after ART initiation. Thus, this study aimed to assess the effect of long-term HAART on the incidence of TB among PLWHIV in Addis Ababa, Ethiopia. Methods: A matched nested case-control study was conducted among PLWHIV who were enrolled in ART clinics in Addis Ababa, Ethiopia from 2013 up to 2018. Cases were HIV-TB co-infected individuals who were taking antiretroviral treatment, while controls were PLWHIV without TB who were taking antiretroviral treatment. The cases and controls are matched exactly in age and sex. Data were entered in Epi Info version 7.1 and analyzed using SPSS version 20. Bi-variable and multivariable conditional logistic regression were employed along with 95% CI. A P-value <0.05 in the multivariable analysis was considered statistically significant. Results: Fifty-seven cases were compared with 114 controls. Accordingly, previous TB history (X 2 ; 13.790, P < 0.001), baseline functional status (X 2 ; 9.120, P = 0.010), baseline WHO clinical stage (X 2 ; 10.083, P = 0.001), baseline hemoglobin value (X 2 ; 6.985, P = 0.008), baseline body mass index (X 2 ; 3.873, P = 0.049), isoniazid preventive treatment (X 2 ; 8.047, P = 0.005), baseline CD4 value (X 2 ; 12.741, P < 0.001) and length of stay on ART (X 2 ; 53.359, P < 0.001) were associated with developing TB. Length of stay on ART was found to be the statistically significant determinant of TB infection after ART initiation (aOR = 5.925, 95% CI = 2.649-13.250). Conclusion:Advanced clinical stages at the baseline, previous TB history, and not taking IPT were associated with TB infection. The long-term ART exposure significantly decreases tuberculosis incidence in PLWHIV. Thus, retaining PLWHIV on ART would be important to decrease the incidence of TB in this group of individuals.

Incidence of lost to follow up among HIV-positive children on antiretroviral therapy in Ethiopia: Systematic review and meta-analysis

“…The finding is consistent with studies conducted elsewhere [ 56 – 58 ]. This is the fact that ART can suppress viral replication, boost immune function, and prevent opportunistic infection [ 59 , 60 ]. Such that, fair or poor ART treatment adherence can open a window for viral replication, cause HIV viral resistance, decrease drug effectiveness, and cause treatment failure.…”

Viral Load and CD4+ Markers as Determinants of Tuberculosis Coinfection Among People Living with HIV/AIDS in Papua Indonesia

“…Overall, other studies have found that although viral suppression is effective after starting antiretroviral therapy (ART), CD4 + recovery is not optimal and may result in a residual risk of developing tuberculosis 28 although ART contributes to an increased incidence of TB. 29,30…”

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

“…The current study also found that ART regimen had a positive statistical significance at a 5% significant level, which showed an improved level of CD4+ counts of coinfected patients, and as a result, improved the survival time of patients, as shown in the AFT model rather than in the Cox PH model. Therefore, a long time of HAART exposure could be important factor in reducing the incidence of TB, and as a result, mortality of the co-infected patients [8]. Inconsistent with a study of [38], in women's first birth interval (FBI) using the log-normal AFT model, education was found as a significant covariate for the survival time of co-infected patients in the hospital, because HAART improves CD4+ counts necessary to fight with HIV/AIDS viruses replication [37,39], and reduces the risk of developing TB [8,40,41].…”

“…Therefore, a long time of HAART exposure could be important factor in reducing the incidence of TB, and as a result, mortality of the co-infected patients [8]. Inconsistent with a study of [38], in women's first birth interval (FBI) using the log-normal AFT model, education was found as a significant covariate for the survival time of co-infected patients in the hospital, because HAART improves CD4+ counts necessary to fight with HIV/AIDS viruses replication [37,39], and reduces the risk of developing TB [8,40,41].…”

“…It was proven that HAART increases the survival of HIV/ TB co-infected patients and reduces their mortality [7]. Studies of Alemu et al [8] and Tiruneh et al [9] confirmed that if HIV/AIDS patients take ART, it enables them to reduce the risk of developing active TB disease. WHO also recommends that all TB patients with HIV should be started on antiretroviral therapy (ART), irrespective of their CD4+ counts [10], and this survival time of patients was often studied by using non-parametric and parametric survival models, including Kaplan-Meier, Cox PH, and AFT models.…”