Impact of HIV Status, CD4 Count and Antiretroviral Treatment on Tuberculosis Treatment Outcomes in a Low-Burden Country

Abstract

Background: Few data is available in low-burden TB-HIV countries on TB treatment outcomes. We evaluated TB patients (pts) characteristics by HIV status and compared treatment outcomes in relation to HIV status, CD4 count and antiretroviral therapy (ART). Methods: We performed a retrospective analysis of 447 adult TB pts who registered and initiated treatment in our center from 2014 to 2015. Results: Pts were categorized as HIV-negative (n = 399, 89.3%), HIV-positive on ART (n = 42, 9.4%) and HIV-positive not on ART (n = 6, 1.3%). The proportion of pts with extended TB therapy was higher among HIV-positive pts (p = 0.03). Increased age was associated with higher death rates regarding treatment success (OR 1.08; 95% CI 1.01-1.17, p = 0.03). Statistically significant higher mortality was found among HIV-positive pts on ART (OR 9.93; 95% CI 1.36-72.37, p = 0.03) and HIV-positive pts not on ART (OR 397.00; 95% CI 44.27 to 3559.91, p ≤ 0.0001) compared to HIV-negative pts. When multivariate analyses were restricted to HIV-positive pts, being not on ART was associated with higher mortality (OR 40.0; 95% CI 4.37-365.78, p = 0.001). Conclusions: There was significant difference in death rates between HIV-positive and HIV-negative TB pts. HIV-positive pts not on ART had a significantly higher mortality.

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

“…The HIV status of TB patients was one of the factors that was associated with the treatment outcome. TB/HIV co-infection was significantly associated with poor TB treatment outcome in the present study and this finding was consistent with several previous studies [ 1 , 6 , 11 , 19 , 20 , 25 , 27 , 34 , 35 , 78 , 83 ]. Several possible explanations could be proposed for the striking difference in treatment success between patients with TB only and those co-infected with HIV.…”

“…Age was found to be one predictor factor for successful treatment outcomes, where the age group of 25–49years was associated with favorable outcomes. Previous studies also supported that being an older age (increased age) was associated with a lower treatment success rate including a higher risk for mortality that needs to be addressed urgently [ 1 , 5 , 10 , 30 , 35 , 44 , 70 , 71 ]. Global TB 2012 reported that TB patients ≥65 years of age had a higher likelihood of unfavorable outcome than those in the other age groups [ 44 , 72 ].…”

“…Management of co-infected patients can be complex because of overlapping drug toxicities and interactions [ 12 , 33 ]. Furthermore, HIV-positive TB patients are a challenge to TB services, as they are more likely to have diagnostic delays [ [32] , [33] , [34] , [35] ]. Duration of treatment, frequency of drug administration, pill burden, and complications of therapy are some of the challenges associated with the coinfection [ 12 , 18 ].…”