HIV-Associated TB in An Giang Province, Vietnam, 2001–2004: Epidemiology and TB Treatment Outcomes

Abstract

BackgroundMortality is high in HIV-infected TB patients, but few studies from Southeast Asia have documented the benefits of interventions, such as co-trimoxazole (CTX), in reducing mortality during TB treatment. To help guide policy in Vietnam, we studied the epidemiology of HIV-associated TB in one province and examined factors associated with outcomes, including the impact of CTX use.Methodology/Principal FindingsWe retrospectively abstracted data for all HIV-infected persons diagnosed with TB from 2001–2004 in An Giang, a province in southern Vietnam in which TB patients receive HIV counseling and testing. We used standard WHO definitions to classify TB treatment outcomes. We conducted multivariate analysis to identify risk factors for the composite outcome of death, default, or treatment failure during TB treatment. From 2001–2004, 637 HIV-infected TB patients were diagnosed in An Giang. Of these, 501 (79%) were male, 321 (50%) were aged 25–34 years, and the most common self-reported HIV risk factor was sex with a commercial sex worker in 221 (35%). TB was classified as smear-positive in 531 (83%). During TB treatment, 167 (26%) patients died, 9 (1%) defaulted, and 6 (1%) failed treatment. Of 454 patients who took CTX, 116 (26%) had an unsuccessful outcome compared with 33 (70%) of 47 patients who did not take CTX (relative risk, 0.4; 95% confidence interval [CI], 0.3–0.5). Adjusting for male sex, rural residence, TB smear status and disease location, and the occurrence of adverse events during TB treatment in multivariate analysis, the benefit of CTX persisted (adjusted odds ratio for unsuccessful outcome 0.1; CI, 0.1–0.3).Conclusions/SignificanceIn An Giang, Vietnam, HIV-associated TB was associated with poor TB treatment outcomes. Outcomes were significantly better in those taking CTX. This finding suggests that Vietnam should consider applying WHO recommendations to prescribe CTX to all HIV-infected TB patients.

TB, HIV‐associated TB and multidrug‐resistant TB on Thailand’s border with Myanmar, 2006–2007

“…We also found that most non‐Thais (as well as Thais) with HIV infection did not receive ART, which is known to be life‐saving in HIV‐associated TB (Akksilp et al. 2007; Thuy et al. 2007).…”

Implementation and evaluation of an isoniazid preventive therapy pilot program among HIV-infected patients in Vietnam, 2008−2010

“…10 During TB treatment, mortality rates in HIV-infected TB patients have averaged 20–30% compared to 3% in HIV-uninfected TB patients, with most deaths occurring during the first 3 months after TB diagnosis. 11 Program experience suggests that delayed diagnosis of HIV and TB and inadequate HIV treatment and care during TB treatment are contributing factors. Additional strategies to reduce the incidence of TB disease and transmission in Vietnam are needed.…”

Causes of Death in HIV-infected Persons Who Have Tuberculosis, Thailand

“…In Southeast Asia, the death rate for HIV-infected TB patients during TB treatment is particularly high, ranging from 20% to 50% (2)(3)(4)(5). HIV-infected patients in Southeast Asia are severely immunocompromised at the time of TB diagnosis, with a median CD4+ T-cell lymphocyte count (CD4) of 54-57 cells/μL (2,(6)(7)(8)(9).…”

“…The reported reduction in death rates from this intervention is large in Africa, but less so in Asia. (2,5,16,(20)(21)(22)(23). No published studies have demonstrated an association between CPT and reduced death rates in HIV-infected TB patients in Asia in the era of antiretroviral therapy (ART) (2,16; US Centers for Disease Control and Prevention [CDC], unpub.…”