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Rossetto M, Brand ÉM, Rodrigues RM, Serrant L, Teixeira LB. Factors associated with hospitalization and death among TB/HIV co-infected persons in Porto Alegre, Brazil. PLoS One 2019; 14:e0209174. [PMID: 30601842 PMCID: PMC6314623 DOI: 10.1371/journal.pone.0209174] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 12/02/2018] [Indexed: 12/27/2022] Open
Abstract
In locations with a high rate of tuberculosis (TB) and HIV infection, there are a number of strategies to prevent negative outcomes such as opportunistic infections, hospitalizations and death, and this article investigates risk factors for the occurrence of hospitalization and death in cases of TB/HIV co-infection in the south of Brazil. The data are taken from a population-based retrospective cohort study on cases of TB/HIV co-infection from 2009 to 2013 in Porto Alegre, Brazil. Sociodemographic, epidemiological and clinical variables were analyzed. Relative risk (RR) estimates for hospitalization and death were determined by regression models. There were 2,419 co-infection cases, of which 1,527 (63.1%) corresponded to hospitalizations, and 662 (27.4%) to death. The occurrence of hospitalization was associated with ≤ 7 years of schooling (RR = 3.47, 95%CI: 1.97–6.29), 8–11 years of schooling (RR = 2.56, 95%CI: 1.44–4.69), place of origin—district health authorities Northwest/Humaitá/Navegantes/Ilhas (RR = 2.01, 95%CI: 1.44–2.82), type of entry into the surveillance system as in cases of reentry after withdrawal (RR = 1,35, 95%CI: 1.07–1.70), closure in surveillance as in withdrawal of treatment (RR = 1.47, 95%CI: 1.18–1.83) and multidrug-resistant tuberculosis (RR = 3.94, 95%CI: 1.97–8.81). The occurrence of death was associated with age (RR = 1.07, 95%CI: 1,01–1,14), ≤ 7 years of schooling (RR = 3.94, 95%CI: 2.26–7.09), 8–11 years of schooling (RR = 2.84, 95%CI: 1.61–5.16), place of origin—district health authorities Baltazar (RR = 2.05, 95%CI: 1.48–2.86), type of entry in the surveillance system as cases of re-entry after withdrawal (RR = 1.53, 95%CI: 1.22–1.91), relapse (RR = 1.33, 95%CI: 1.03–1.73). The occurrence of hospitalizations and deaths is high among co-infected patients. Our estimation approach is important in order to identify, from the surveillance data, the risk factors for hospitalization and death in co-infected patients, so that they may receive more attention from the Brazilian national healthcare system.
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Affiliation(s)
- Maíra Rossetto
- Department of Medicine, Universidade Federal da Fronteira Sul, Chapecó, Santa Catarina, Brasil
| | - Évelin Maria Brand
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Laura Serrant
- Faculty of Health and Wellbeing, Sheffield Hallam University, South Yorkshire, England, United Kingdom
| | - Luciana Barcellos Teixeira
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
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Teklu AM, Nega A, Mamuye AT, Sitotaw Y, Kassa D, Mesfin G, Belayihun B, Medhin G, Yirdaw K. Factors Associated with Mortality of TB/HIV Co-infected Patients in Ethiopia. Ethiop J Health Sci 2018; 27:29-38. [PMID: 28465651 PMCID: PMC5402803 DOI: 10.4314/ejhs.v27i1.4s] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite the large number of TB patients on ART in Ethiopia, their mortality remains high. This study reports the effect of TB on HIV related mortality and determinants of TB/HIV co-infection related mortality. METHODS A longitudinal study design was employed as part of the Advanced Clinical Monitoring of ART (ACM) in Ethiopia. All patients started on ART at or after January 1, 2005 were included. Survival analysis was done to compare survival patterns of HIV patients with TB against HIV patients without TB. In addition, determinants of survival among TB/HIV co-infected patients were analyzed. Adjusted effects of the different factors on time to death were generated using Cox-proportional hazards regression. RESULTS A total of 3,889 patients were enrolled in the ACM study, of which 355 TB cases were identified, making the crude prevalence 9% (95% CI 8.3 - 10.2). Overall, incidence of TB was 2.2 (95% CI 1.9-2.4) per 100 person-years. TB was highest in the first 2 months and declined with time on ART to reach 1 per 100 person years after 24 months on ART. TB was significantly associated with mortality among HIV patients on HAART (AHR 2.0, 95% CI 1.47-2.75). Male gender was associated with mortality among TB/HIV co-infected patients. CONCLUSION Tuberculosis plays a key role in HIV associated mortality. Targeted interventions which can keep patients free of TB in the early stages of their treatment are required to reduce TB related mortality.
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Affiliation(s)
- Alula M Teklu
- Alula M. Teklu: MERQ Consultancy Services, Addis Ababa, Ethiopa
| | - Abiy Nega
- Abiy Nega: MERQ Consultancy Services, Addis Ababa, Ethiopia
| | - Admasu Tenna Mamuye
- Admasu Tenna Mamuye: Addis Ababa University, Medical Faculty, Addis Ababa, Ethiopia
| | - Yohannes Sitotaw
- Yohannes Sitotaw: Ministry of Science and Technology, Addis Ababa, Ethiopia
| | - Desta Kassa
- Desta Kassa: Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getnet Mesfin
- Getnet Mesfin: Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bekele Belayihun
- Mekele Belayhiun: Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Girmay Medhin: Aklilu Lemma Institute of Pathobiology, Addis Ababa
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Mortality and Its Predictors among HIV Infected Patients Taking Antiretroviral Treatment in Ethiopia: A Systematic Review. AIDS Res Treat 2017; 2017:5415298. [PMID: 29214077 PMCID: PMC5682904 DOI: 10.1155/2017/5415298] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/18/2017] [Accepted: 10/03/2017] [Indexed: 11/18/2022] Open
Abstract
Background Even though the benefit of antiretroviral therapy (ART) is well established, there is a regional variation in the extent of its benefit. The aim of this review is to highlight mortality and its predictors in Ethiopian adult HIV patients who were on ART. Methods Relevant articles were searched on PubMed and Google Scholar databases. The search terms used in different combinations were predictor/determinant/factors, mortality/death/survival, HIV, ART/HAART, and Ethiopia. Result 5-40.8% of the patients died during the follow-up period. More than half (50-68.8%) of the deaths occurred within 6 months of initiating ART. Advanced stage disease (stage III and stage IV), nonworking functional status (bedridden and ambulatory), low baseline CD4 count, low baseline hemoglobin level, TB coinfection, lower baseline weight, and poor treatment adherence were commonly identified as predictors of death in HIV patients. Conclusion 5-40.8% of HIV patients in Ethiopia die in 2-5 years of initiating antiretroviral treatment. Most of the deaths in HIV patients occur early in the course of treatment. Special emphasis should be given for patients with advanced stage disease, nonworking functional status, low baseline CD4 count, low baseline hemoglobin level, TB coinfection, lower baseline weight, and poor treatment adherence.
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Marked sex differences in all-cause mortality on antiretroviral therapy in low- and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc 2016; 19:21106. [PMID: 27834182 PMCID: PMC5103676 DOI: 10.7448/ias.19.1.21106] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 09/15/2016] [Accepted: 10/06/2016] [Indexed: 01/14/2023] Open
Abstract
Introduction While women and girls are disproportionately at risk of HIV acquisition, particularly in low- and middle-income countries (LMIC), globally men and women comprise similar proportions of people living with HIV who are eligible for antiretroviral therapy. However, men represent only approximately 41% of those receiving antiretroviral therapy globally. There has been limited study of men’s outcomes in treatment programmes, despite data suggesting that men living with HIV and engaged in treatment programmes have higher mortality rates. This systematic review (SR) and meta-analysis (MA) aims to assess differential all-cause mortality between men and women living with HIV and on antiretroviral therapy in LMIC. Methods A SR was conducted through searching PubMed, Ovid Global Health and EMBASE for peer-reviewed, published observational studies reporting differential outcomes by sex of adults (≥15 years) living with HIV, in treatment programmes and on antiretroviral medications in LMIC. For studies reporting hazard ratios (HRs) of mortality by sex, quality assessment using Newcastle–Ottawa Scale (cohort studies) and an MA using a random-effects model (Stata 14.0) were conducted. Results A total of 11,889 records were screened, and 6726 full-text articles were assessed for eligibility. There were 31 included studies in the final MA reporting 42 HRs, with a total sample size of 86,233 men and 117,719 women, and total time on antiretroviral therapy of 1555 months. The pooled hazard ratio (pHR) showed a 46% increased hazard of death for men while on antiretroviral treatment (1.35–1.59). Increased hazard was significant across geographic regions (sub-Saharan Africa: pHR 1.41 (1.28–1.56); Asia: 1.77 (1.42–2.21)) and persisted over time on treatment (≤12 months: 1.42 (1.21–1.67); 13–35 months: 1.48 (1.23–1.78); 36–59 months: 1.50 (1.18–1.91); 61 to 108 months: 1.49 (1.29–1.71)). Conclusions Men living with HIV have consistently and significantly greater hazards of all-cause mortality compared with women while on antiretroviral therapy in LMIC. This effect persists over time on treatment. The clinical and population-level prevention benefits of antiretroviral therapy will only be realized if programmes can improve male engagement, diagnosis, earlier initiation of therapy, clinical outcomes and can support long-term adherence and retention.
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Bigna JJR, Noubiap JJN, Agbor AA, Plottel CS, Billong SC, Ayong APR, Koulla-Shiro S. Early Mortality during Initial Treatment of Tuberculosis in Patients Co-Infected with HIV at the Yaoundé Central Hospital, Cameroon: An 8-Year Retrospective Cohort Study (2006-2013). PLoS One 2015. [PMID: 26214516 PMCID: PMC4516239 DOI: 10.1371/journal.pone.0132394] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Understanding contributors to mortality during the initial phase of tuberculosis (TB) treatment in patients co-infected with HIV would guide targeted interventions to improve survival. The aim of this study was to ascertain the incidence of death during the initial 2 months (new cases) and 3 months (retreatment cases) of TB treatment and to assess correlates of mortality in HIV co-infected patients. Methods We conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify co-infected TB/HIV inpatients aged 15 years and older who died during TB treatment. Death was defined as any death occurring during TB treatment, as per World Health Organization recommendations. We collected socio-demographic, clinical and laboratory data. We conducted multivariable logistic binary regression analysis to identify factors associated with death during the intensive phase of TB treatment. Magnitudes of associations were expressed by adjusted odds ratio (aOR) with 95% confidence interval. A p value < 0.05 was considered statistically significant. Results The 99 patients enrolled had a mean age of 39.5 (standard deviation 10.9) years and 53% were male. Patients were followed for 276.3 person-months of observation (PMO). Forty nine patients were died during intensive phase of TB treatment. Death incidence during the intensive phase of TB treatment was 32.2 per 100 PMO. Having a non-AIDS comorbidity (aOR 2.47, 95%CI 1.22-5.02, p = 0.012), having extra-pulmonary TB (aOR 1.89, 95%CI 1.05-3.43, p = 0.035), and one year increase in duration of known HIV infection (aOR 1.23, 95%CI 1.004-1.49) were independently associated with death during the intensive phase of TB treatment. Conclusions Mortality incidence during intensive phase of TB treatment was high among TB/HIV co-infected patients during TB treatment; and strongly associated with extra pulmonary TB suggesting advanced stage of immunosuppression and non-AIDS comorbidities. Early HIV diagnosis and care and good management of non-comorbidities can reduce this incidence.
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Affiliation(s)
- Jean Joel R. Bigna
- Department of Epidemiology and Public Health, Pasteur Center of Cameroon, Yaoundé, Cameroon
- * E-mail:
| | - Jean Jacques N. Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Medical Diagnosis Center, Yaoundé, Cameroon
| | - Ako A. Agbor
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Claudia S. Plottel
- Department of Medicine, NYU-Langone Medical Center, New York, New York, United States of America
| | - Serge Clotaire Billong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- National AIDS control committee, Ministry of Public Health, Yaoundé, Cameroon
| | | | - Sinata Koulla-Shiro
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Infectious Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
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Agbor AA, Bigna JJR, Plottel CS, Billong SC, Tejiokem MC, Ekali GL, Noubiap JJN, Toby R, Abessolo H, Koulla-Shiro S. Characteristics of patients co-infected with HIV at the time of inpatient tuberculosis treatment initiation in Yaoundé, Cameroon: a tertiary care hospital-based cross-sectional study. ACTA ACUST UNITED AC 2015; 73:24. [PMID: 25941570 PMCID: PMC4418067 DOI: 10.1186/s13690-015-0075-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/07/2015] [Indexed: 12/26/2022]
Abstract
Background Knowledge of the characteristics of patients co-infected with tuberculosis (TB) and human immunodeficiency virus (HIV) when TB treatment is initiated would allow clinicians to improve care and help policy-makers develop relevant and realistic guidelines. The aim of this study was to describe socio-demographic, clinical, and laboratory characteristics of TB/HIV co-infected patients starting inpatient TB treatment in Yaoundé, Cameroon. Methods We conducted a retrospective cross-sectional study, collecting data from medical records of HIV-infected patients with TB, aged 15 years old or more, hospitalized in the Infectious Diseases Unit of the Yaoundé Central Hospital, Cameroon from January 1, 2006 to June 30, 2013. Results The mean age of 337 patients meeting study inclusion criteria was 39.3 years. More than half were female (53.4%). Most (89.3%) resided in urban areas, 44.2% had a secondary education, and 46.0% were married. The majority was receiving co-trimoxazole prophylaxis (79.5%), and two thirds were taking antiretroviral therapy (67.4%). The mean duration of known HIV infection before TB treatment was 8.4 months. Most (88.1%) had newly diagnosed TB, rather than relapsed disease. Smear-positive pulmonary TB was documented in a third, (35.3%). Laboratory data revealed a median white blood cell count of 5,100 cells/mm3 (IQR 3,300-7,990 cells/mm3), a median hemoglobin level of 8 g/dl (IQR 7–10 g/dl), and a median CD4 cell count of 102 cells/mm3 (IQR 33–178 cells/mm3). Sex differences in our study included older age in the men (p < 0.001), more of whom were married (p < 0.001) and had achieved a higher level of education (p = 0.042). Men had fewer diagnoses of smear-positive pulmonary TB (p = 0.020). They weighed more than the women (p = 0.001) and had higher hemoglobin levels (p = 0.003). Conclusions Suboptimal adherence to WHO treatment recommendations in our Cameroonian study reinforces the importance of prescribing co-trimoxazole in HIV infection and ART for all TB/HIV co-infected persons. We urge that Ministries of Health continue implementing and disseminating guidelines for management of TB/HIV co-infected patients, and we call for measures ensuring that healthcare facilities’ stocks of ART and co-trimoxazole are sufficient to meet the need for both.
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Affiliation(s)
- Ako A Agbor
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | - Claudia S Plottel
- Department of Medicine, New York University Langone Medical Center, New York, USA ; Department of Medicine, New York University School of Medicine, New York, USA
| | - Serges Clotaire Billong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon ; National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Mathurin Cyrille Tejiokem
- Department of Epidemiology and Public Health, Centre Pasteur du Cameroun, Member of International Network of the Pasteur Institutes, Garoua, Cameroon
| | - Gabriel L Ekali
- National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Jean Jacques N Noubiap
- Internal Medicine Unit, Edéa Regional Hospital, Edéa, Cameroon ; Medical Diagnostic Center, Yaounde, Cameroon
| | - Roselyne Toby
- Infectious Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Hermine Abessolo
- Infectious Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Sinata Koulla-Shiro
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon ; Infectious Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
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Tadesse K, Haile F, Hiruy N. Predictors of mortality among patients enrolled on antiretroviral therapy in Aksum hospital, northern Ethiopia: a retrospective cohort study. PLoS One 2014; 9:e87392. [PMID: 24498093 PMCID: PMC3909114 DOI: 10.1371/journal.pone.0087392] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/21/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Since launching of antiretroviral (ART) treatment, the numbers of patients enrolled in to ART are increasing in many developing countries. But many studies done across Africa including Ethiopia on antiretroviral therapy programs have shown higher mortality at the first six months of treatment initiation. But the factors associated with this high mortality are poorly characterized. So this study aims to determine mortality and identify predictors of it among patients on ART. METHODS Retrospective cohort study was employed among a total of 520 records of patients who were enrolled on antiretroviral therapy in Aksum hospital from September 2006 to August 2011. Baseline patient records were extracted from electronic and paper based medical records database and analysed using Kaplan Meier survival and Cox proportional hazard model to identify the independent predictors of mortality of patients on ART. RESULTS A total of 46 (8.85%) deaths was observed giving an overall mortality rate of 3.2 per 100 person-years. The independent predictor of mortality identified for this cohort were haemoglobin level <11 mg/dl (Hazard Ratio (HR) = 1.9, 95%-CI = 1.01, 3.52), CD4 cell counts lower than 50 cells/µl (HR = 2.1, 95%- CI = 1.13,3.89), Male gender (HR = 1.9, 95%-CI = 1.01,3.52), Weight <40 kg (HR = 2.3,95% CI = 1.24,4.55), primary level of education and lower (HR = 2.6, 95%- CI = 1.29,5.55). CONCLUSIONS The over all mortality of adults patients on ART was low but higher in the early months of ART initiation. low levels of haemoglobin <11 gm/dl, lower CD4 cell count, male gender, weight <40 Kg and individuals who have primary level of education and lower were identified as the independent predictors of mortality. For this reason, early initiation of ART despite the CD4 count and method of HIV diagnosis, nutritional support and close monitoring of patients in the early periods of ART treatment initiation is very crucial to improve patient survival.
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Affiliation(s)
- Kidane Tadesse
- Mekelle University, College of Health Science, Department of Public Health, Mekelle, Ethiopia
| | - Fisaha Haile
- Mekelle University, College of Health Science, Department of Public Health, Mekelle, Ethiopia
- * E-mail:
| | - Neway Hiruy
- Mekelle University, College of Health Science, Department of Public Health, Mekelle, Ethiopia
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