Predictors of death among TB/HIV co-infected patients on tuberculosis treatment in Sichuan, China: A retrospective cohort study

Abstract

Mycobacterium tuberculosis is the most common opportunistic infection among patients with human immunodeficiency virus (HIV) infection, and it is also the leading cause of death, causing approximately one-third of acquired immune deficiency syndrome deaths worldwide. China is on the World Health Organization's global list of 30 high-tuberculosis (TB) burden countries. The objective of this study was to evaluate the mortality rate, survival probabilities, and factors associated with death among patients with TB/HIV co-infection undergoing TB treatment in Sichuan, China. A retrospective cohort study was conducted using the Chinese National TB Surveillance System data of TB/HIV co-infected patients enrolled in TB treatment from January 2020 to December 2020. We calculated the mortality rate and survival probabilities using the Kaplan–Meier estimator, and a Cox proportional hazard model was conducted to identify independent risk factors for TB/HIV co-infection mortality. Hazard ratios and their respective 95% confidence intervals were also reported in this study. Of 828 TB/HIV co-infected patients, 44 (5.31%) died during TB treatment, and the crude mortality rate was 7.76 per 1000 person-months. More than half of the deaths (n = 23) occurred in the first 3 months of TB treatment. Overall survival probabilities were 97.20%, 95.16%, and 91.75% at 3rd, 6th, and 12th month respectively. The independent risk factors for mortality among TB/HIV co-infected patients were having extra-pulmonary TB and pulmonary TB co-infection, history of antiretroviral therapy interruption, and baseline cluster of differentiation 4 T-lymphocyte counts <200 cells/μL at the time of HIV diagnosis. Antiretroviral therapy is important for the survival of TB/HIV co-infected patients, and it is recommended to help prolong life by restoring immune function and preventing extra-pulmonary TB.

Incidence rate of mortality and its predictors among tuberculosis and human immunodeficiency virus coinfected patients on antiretroviral therapy in Ethiopia: systematic review and meta-analysis

“…The pooled mortality rate of 12.49 (95% CI: 9.24-15.74) per 100 PYO among TB/HIV-coinfected patients in Ethiopia was consistent with 10.1 per 100 PYO in South Africa (41) and 9.44 per 100 PYO in China (42). On the other hand, this study was higher than studies done in Cameroon (32.2 per 100 PMO) (18), Mozambique (6.8 per 100 PY) (43), Uganda (15.42 per 1,000 PY) (44), and England (2.13 per 100 PY) (45).…”

Long-term survival experience of tuberculosis patients in a rural district of Ghana

“…Also, males have poor health-seeking behaviour than females in our part of the country which may adversely impact their treatment adherence and outcomes. Several studies have also reported the lethal synergy between TB and HIV [7,[27][28][29][30][31]. In congruence, Amante and Ahemed [32] and Teketelew et al [20] demonstrated that younger age and Pulmonary negative TB cases were at significant risk of survival.…”

Prevalence, treatment outcomes and determinants of TB/HIV coinfection: A 4-year retrospective review of national tuberculosis registry in a country in a MENA region

“…HIV and TB are two lethal infectious diseases that are interconnected [ 1 ], in such a way that the co-occurrence of both results in a significant public health challenge [ 2 ]. The prevalence of TB is rising rapidly in regions with high HIV rates, posing a new obstacle to TB control [ 3 ]. Various studies have demonstrated the harmful interactions between HIV and TB, which negatively impact population health [ 4 ].…”