Predictors of mortality in a cohort of tuberculosis/HIV co-infected patients in Southwest Ethiopia

Gesesew, Hailay Abrha; Tsehayneh, Birtukan; Massa, Desalegn; Kahsay, Hafte; Mwanri, Lillian

doi:10.1186/s40249-016-0202-1

Cited by 17 publications

(22 citation statements)

References 21 publications

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“…We used retrospective cohort study in ART clinic at JUTH in Southwest Ethiopia using patient records from June 2003 to March 2015. Details of the study setting has been described elsewhere [ 24 – 26 ]. All HIV-infected children and adults enrolled for ART care in JUTH were the target population.…”

Section: Methodsmentioning

confidence: 99%

Early mortality among children and adults in antiretroviral therapy programs in Southwest Ethiopia, 2003–15

et al. 2018

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BackgroundSeveral studies reported that the majority of deaths in HIV-infected people are documented in their early antiretroviral therapy (ART) follow-ups. Early mortality refers to death of people on ART for follow up period of below 24 months due to any cause. The current study assessed predictors of early HIV mortality in Southwest Ethiopia.MethodsWe have conducted a retrospective analysis of 5299 patient records dating from June 2003- March 2015. To estimate survival time and compare the time to event among the different groups of patients, we used a Kaplan Meir curve and log-rank test. To identify mortality predictors, we used a cox regression analysis. We used SPSS-20 for all analyses.ResultsA total of 326 patients died in the 12 years follow-up period contributing to 6.2% cumulative incidence and 21.7 deaths per 1000 person-year observations incidence rate. Eighty-nine percent of the total deaths were documented in the first two years follow up—an early-term ART follow up. Early HIV mortality rates among adults were 50% less in separated, divorced or widowed patients compared with never married patients, 1.6 times higher in patients with baseline CD4 count <200 cells/μL compared to baseline CD4 count ≥200 cells/μL, 1.5 times higher in patients with baseline WHO clinical stage 3 or 4 compared to baseline WHO clinical stage 1 or 2, 2.1 times higher in patients with immunologic failure compared with no immunologic failure, 60% less in patients with fair or poor compared with good adherence, 2.9 times higher in patients with bedridden functional status compared to working functional status, and 2.7 times higher with patients who had no history of HIV testing before diagnosis compared to those who had history of HIV testing. Most predictors of early mortality remained the same to the predictors of an overall HIV mortality. When discontinuation was assumed as an event, the predictors of an overall HIV mortality included age between 25–50 years, base line CD4 count, developing immunologic failure, bedridden functional status, and no history of HIV testing before diagnosis.ConclusionsThe great majority of deaths were documented in the first two years of ART, and several predictors of early HIV mortality were also for the overall mortality when discontinuation was assumed as event or censored. Considering the above population, interventions to improve HIV program in the first two years of ART follow up should be improved.

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Section: Methodsmentioning

confidence: 99%

Early mortality among children and adults in antiretroviral therapy programs in Southwest Ethiopia, 2003–15

et al. 2018

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“…In addition, studies conducted in North West and South West part of Ethiopia identified inconsistent predictors (11,12). This study was aimed to determine time to death and its predictors among TB-HIV co-infected adult patients in MTUTH.…”

Section: Introductionmentioning

confidence: 99%

Time to death and its Predictors among Adult TB/HIV Co-Infected Patients in Mizan Tepi University Teaching Hospital, South West Ethiopia

Wondimu

Dube

Kabeta

2019

Preprint

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Background: Tuberculosis (TB) and Human Immuno Deficiency Virus (HIV) co-infection represents a complex pathogenic scenario with synergistic effect and leads to about 300,000 HIV-associated TB deaths in the world in 2017. Despite this burden of death, time to death and its predictors among TB-HIV co-infected patient was not adequately studied; and the existing evidences are inconsistent. Therefore, this study was aimed to determine time to death and identify its predictors among adult TB/HIV co-infected patients. Method: Retrospective cohort study was conducted by reviewing registers of randomly selected 364 TB/HIV co-infected patients enrolled in health care from July 2, 2007 up to July 1, 2017 at Mizan Tepi University Teaching Hospital. The hospital was located in Bench Maji Zone, South West Ethiopia. Data were collected from March 1 through 31, 2018, entered to Epi data 3.1 and exported to SPSS version 21. Each patient was followed from date of TB treatment initiation till death, loss to follow up and treatment completed. On the other hand, events other than death were considered as censored. After checking the proportional hazard model assumption, Cox-regression was used to identify the predictors. In bivariable analyses, P-value≤0.25 was used to identify candidate variables for multivariable analysis. The 95% CI of hazard ratio (HR) with respective P-value <0.05 was used to declare significance in the final model. Result: All the 364 patients were followed for 1,654 person months. There were 83 (22.8%) deaths and most 38 (45.8%) were occurring within the first two months of anti-TB treatment initiation. The overall incidence rate and median survival time were 5.02 per 100 person months (95% CI: 4.05, 6.22) and 10 months respectively. Statistically significant better survival was observed among patients: with CD4 ≥ 200 cells/mm3 (P<0.001), who had a history of cotrimoxazole preventive therapy (CPT) use (P<0.001), who disclose their HIV status (P<0.001) and with working functional status (P<0.001). Not using CPT (adjusted hazard ratio [AHR] =1.72; P=0.023), bedridden functional status (AHR=2.55; P=0.007), not disclosing HIV status (AHR=4.03; P<0.001) and CD4 < 200 cells/mm3 (AHR=6.05; P<0.001) were predictors of time to death among TB/HIV co-infected patients. Conclusion: The median survival time was 10 months and poor survival was associated with low CD4 count, not using CPT, not disclosing HIV status and having bedridden functional status. Close monitoring of bedridden and low CD4 count patients, prompt CPT initiation and encouraging HIV status disclosure are recommended. Key words: TB/HIV co-infection, South West Ethiopia, time to death, MTUTH

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“…A diferença de sobrevida entre indivíduos com TB e TB/HIV não apresentou significância estatística, embora a mediana entre o grupo com a coinfecção tenha sido maior, ou seja, estes sobreviveram mais dias do que o grupo com apenas TB; uma questão que pode justificar este resultado é o fato que pessoas vivendo com HIV/Aids recebem acompanhamento de saúde contínuo de equipe multiprofissional, com consultas, exames e dispensação dos medicamentos periodicamente, o que leva a um contato intermitente com os profissionais de saúde e aumenta as oportunidades de reconhecimento de sinais e sintomas da TB, o que é inclusive recomendado nos protocolos de manejo destes pacientes: a investigação da TB em toda consulta (BRASIL 2013). Outros estudos encontram que a coinfecção com HIV esteve associada a mortes precoces por TB (CECCON et al, 2017;GESESEW et al, 2016;GAIFER et al, 2016;PECEGO et al, 2016).…”

Section: Discussionunclassified

“…Alguns estudos (OLIVEIRA et al, 2019;FERREIRA et al, 2018;LEE et al, 2017;PECEGO et al, 2016;BIGNA et al, 2015;FIELD et al, 2014) investigaram as mortes precoces por TB e fatores associados e, dentre aqueles identificados, encontraram a presença de comorbidades como HIV (CECCON et al, 2017;GESESEW et al, 2016;GAIFER et al, 2016;PECEGO et al, 2016;FIELD et al, 2014 ), doenças do aparelho respiratório, derrame pleural (OLIVEIRA et al, 2019;YEN et al, 2017)…”

Section: Autores/ Ano Publicaçãounclassified

“…, baixo IMC(GAIFER et al, 2016), ser acamado(GESESEW et al, 2016), doença renal(WU et al, 2015) uso de álcool(KATTAN et al, 2012) Bigna et al 2015. concluíram que 49% dos pacientes morreram na fase intensiva do tratamento, isto é, antes de completarem 2 meses.Diante da literatura analisada, observou-se que determinantes sociais se relacionam com a mortalidade por TB; no entanto, podem ser mensurados de diferentes maneiras e de acordo com as regiões e nível de observação, de forma ecológica (dados agregados) e ou mesmo individual, por meio de um estudo de coorte retrospectiva.…”

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Os determinantes da mortalidade por Tuberculose e TB-HIV no Sul do Brasil: Da abordagem espacial à análise de sobrevida

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Predictors of mortality in a cohort of tuberculosis/HIV co-infected patients in Southwest Ethiopia

Cited by 17 publications

References 21 publications

Early mortality among children and adults in antiretroviral therapy programs in Southwest Ethiopia, 2003–15

Early mortality among children and adults in antiretroviral therapy programs in Southwest Ethiopia, 2003–15

Time to death and its Predictors among Adult TB/HIV Co-Infected Patients in Mizan Tepi University Teaching Hospital, South West Ethiopia

Os determinantes da mortalidade por Tuberculose e TB-HIV no Sul do Brasil: Da abordagem espacial à análise de sobrevida

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