Effect of HIV infection on TB treatment outcomes and time to mortality in two urban hospitals in Ghana-a retrospective cohort study

Abstract

Introduction Tuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally. Ghana as one of the 30 high burden TB/HIV countries has a high annual TB case-fatality rate of 10%. The study sought to assess the effect of HIV infection on TB treatment outcomes and assess the time to mortality after treatment onset. Methods We conducted a review of treatment files of TB patients who were treated from January 2013 to December 2015 in two urban hospitals in the Accra Metropolis. Modified Poisson regression analysis was used to measure the association between HIV infection and TB treatment outcomes. Kaplan-Meier survival estimates were used to plot survival curves. Results Seventy-seven percent (83/107) of HIV infected individuals had successful treatment, compared to 91.2% (382/419) treatment success among HIV non-infected individuals. The proportion of HIV-positive individuals who died was 21.5% (23/107) whilst that of HIV-negative individuals was 5.5% (23/419). Being HIV-positive increased the risk of adverse outcome relative to successful outcome by a factor of 2.89(95% CI 1.76-4.74). The total number of deaths recorded within the treatment period was 46; of which 29(63%) occurred within the first two months of TB treatment. The highest mortality rate observed was among HIV infected persons (38.6/1000 person months). Of the 107 TB/HIV co-infected patients, 4(3.7%) initiated ART during TB treatment. Conclusion The uptake of ART in co-infected individuals in this study was very low. Measures should be put in place to improve ART coverage among persons with TB/HIV co-infection to help reduce mortality.

Impact of HIV status and predictors of successful treatment outcomes among tuberculosis patients: A six-year retrospective cohort study

“…The co-infection has emerged as a major public health threat throughout the world compared to patients with TB alone [ [14] , [15] , [16] , [17] , [18] ]. The risk of mortality from TB is significantly higher in the HIV-infected population [ 13 , [19] , [20] , [21] , [22] ] due to the shared immune defense mechanisms and HIV has also contributed to a worldwide resurgence of TB [ [23] , [24] , [25] , [26] ].…”

“…The clinical burden of HIV patients was worsened by the concomitant infection of TB which becomes major global health threats [ 17 , 18 , 27 ]. Untreated TB accelerates the progression of HIV infection to AIDS [ 21 ]. This is due to the HIV epidemic has greatly altered the epidemiological course of TB and modifies the natural history [ 22 , 28 , 29 ].…”

“…Early diagnosis and effective treatment of active TB disease in HIV-infected patients is imperative for curing TB and decreasing its ill effects [ 38 ]. Administration of concurrent ART and anti-TB therapy reduces the risk of death among TB/HIV co-infected patients [ 21 ]. But drug-drug interactions between HIV and TB therapy are common [ 12 ].…”

“…The incidence of TB has been increasing steadily since the 1990s, particularly in African countries [ 45 ], and an estimated 30% of HIV infected persons have a dual infection with TB in SSA countries [ 44 ]. In 2015, about 75% of TB/HIV deaths worldwide occurred in SSA, with case fatality rates varying from under 5% to over 20% among countries in the region [ 2 , 21 ]. Regional and global profiles of the World Health Organization (WHO) of 2019 estimates of TB burden in Africa region has shown that the rate of total TB incidence was 231 per 100 000 population and HIV-positive TB incidence was 58 per 100, 000 populations [ 7 ].…”

“…The WHO and the National Tuberculosis and Leprosy Control Programme (NTBLCP) recommended a case detection rate of 70% and a treatment success rate (TSR) of 85% for all TB cases [ 41 ]. Interventions are necessary to reduce deaths during TB treatment for the country to achieve the targets set in the End TB Strategy by 2035 [ 21 ]. The integration of TB-HIV collaborative activities will help to reduce mortality, default, relapse, and drug resistance [ 12 , 31 , 40 ].…”