Reduction of HIV-associated excess mortality by antiretroviral treatment among tuberculosis patients in Kenya

Abstract

BackgroundMortality from TB continues to be a global public health challenge. TB ranks alongside Human Immunodeficiency Virus (HIV) as the leading infectious causes of death globally. HIV is a major driver of TB related morbidity and mortality while TB is the leading cause of mortality among people living with HIV/AIDS. We sought to determine excess mortality associated with HIV and the effect of antiretroviral therapy on reducing mortality among tuberculosis patients in Kenya.MethodsWe conducted a retrospective analysis of Kenya national tuberculosis program data of patients enrolled from 2013 through 2014. We used direct standardization to obtain standardized mortality ratios for tuberculosis patients compared with the general population. We calculated the population attributable fraction of tuberculosis deaths due to HIV based on the standardized mortality ratio for deaths among TB patients with HIV compared to TB patients without HIV. We used Cox proportional hazards regression for assessing risk factors for mortality.ResultsOf 162,014 patients included in the analysis, 6% died. Mortality was 10.6 (95% CI: 10.4–10.8) times higher among TB patients than the general population; 42% of deaths were attributable to HIV infection. Patients with HIV who were not receiving ART had an over four-fold risk of death compared to patients without HIV (aHR = 4.2, 95% CI 3.9–4.6). In contrast, patients with HIV who were receiving ART had only 2.6 times the risk of death (aHR = 2.6, 95% CI 2.5–2.7).ConclusionHIV was a significant contributor to TB-associated deaths in Kenya. Mortality among HIV-infected individuals was higher among those not on ART than those on ART. Early initiation of ART among HIV infected people (a “test and treat” approach) should further reduce TB-associated deaths.

Bayesian Modeling of Spatiotemporal patterns of TB-HIV co-infection risk in Kenya

“…In 2016 alone, the SSA region accounted for an estimated 86% of HIVlinked TB deaths (18). Kenya is one of the countries in SSA severely hit by the dual epidemic and appears among the WHO high TB and TB-HIV burden countries ranking 13 out of the 22 countries globally (19,20).…”

Bayesian hierarchical modeling of joint spatiotemporal risk patterns for Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) in Kenya

“…million incidences of TB annually [50,51]. They have a close link even though their biological co-existence and co-dynamics vary regionally with much burden in Sub-Saharan Africa [31,52].…”

Who were the tuberculosis patients who died precociously due to the disease in southern Brazil? A retrospective cohort study.

“…One such study in Korea observed similar results with a median survival time of 21 days [13]; another study found that 19% of the patients died within 7 days and 41% died within the first month after the start of treatment for TB [14]. Another study, performed in Africa, found a mean survival span of two months in 53.3% of the people who started their TB treatment; in this case, mortality among HIV-positive people was higher than for those who were HIV-negative or whose HIV status was unknown [3].…”

“…Studies using the technique of survival analysis have found that death from TB is most common in the first three months after diagnosis among patients with coinfection with human immunodeficiency virus and TB (TB/HIV) [8], while another study observed that the majority of deaths took place within two months after the start of treatment for TB [3]. A study investigating an HIV-negative population found that the median survival was 12 days, considering those who died of TB [9].…”

“…A study investigating an HIV-negative population found that the median survival was 12 days, considering those who died of TB [9]. Some studies that evaluated survival in relation to TB focused mainly on people with TB/HIV coinfection [3,8,10,11] and on the delay in the commencement of treatment for TB, considering the period from diagnosis to the start of antituberculosis activities [8,12]. Some studies have addressed the issue of premature deaths from TB [9,11,13], considering those deaths which occurred in the intensive stage of treatment, which comprises the first two months of treatment [9,14].…”