Open Access Research Article

Predictors of Accelerated Mortality of Tb/Hiv Co- Infected Patients on Art in Mekelle, Ethiopia: an 8 Years Retrospective Follow- Up Study

Kebede Embaye Gezae1*, Haftom Temesgen Abebe1, Letekirstos Gebre-Egziabher Gebretsadik1 and Abrha Kidu Gebremeskel2

1Department of Biostatistics, Mekelle University: Mekelle, Ethiopia

2Department of Water Resources and Irrigation Engineering, Aksum University (Shire Campus): Shire, Ethiopia

Corresponding Author

Received Date: December 10, 2019;  Published Date: December 19, 2019

Abstract

Background: Ethiopia is a country with high burden of tuberculosis and human immunodeficiency virus (TB-HIV) dual infections in the world. However, little was known so far on predictors of time to death among TB/HIV co-infected adults in the study setting in particular. Therefore, this study was aimed at filling this gap in the region particularly.

Methods: A hospital based retrospective cohort study design was employed on 305 Tuberculosis and Human Immunodeficiency Virus (TB/ HIV) co-infected adults who have started Anti-Retroviral Therapy (ART) from January 2009 to December 2016 at two governmental hospitals in Mekelle, Ethiopia. Multivariable cox regression analysis was applied to identify statistically significant predictors of time to death (P ≤ 0.05). Finally, Adjusted Hazard Ratio (AHR) and 95% Confidence Interval (CI) were interpreted and reported in the final cox model.

Results: Overall, 70 of 305 (23.0%) TB/HIV co-infected adults were died during the entire follow-up period. The study subjects (257 Active TB, 48 Latent TB) were followed for an overall median follow up time of 37 months (Interquartile Range: 10-63 months). Baseline Body Mass Index (< 18.5 kg/m2) (AHR=2.427; 95% CI: 1.214 - 4.853) and Being Extra-pulmonary TB (Mixed TB) patient (AHR=2.400; 95% CI: 0.220-0.697) were predictors of time to death. On the other hand, increasing CD4 cell count (AHR=0.995; 95% CI: 0.991-0.999), developing drug side effects (AHR=0.369; 95% CI: 0.194–0.701), being co-infected with Latent TB infection (AHR=0.102; 95% CI: 1.023-0.449), completing TB treatment (AHR=0.114; 95% CI: 0.060–0.16), and being on Cotri-moxazole Prophylactic Therapy (AHR=0.391; 95% CI: 1.348, 4.273) had prolonged the time to death.

Conclusions: Almost one-fourth of TB/HIV co-infected patients were died with a relatively high mortality rate among those co-infected with active TB since ART initiation. Moreover, being co-infected with active TB/HIV, having low baseline BMI (≤ 18.5 g/dl), Low CD4 cell count, not developing drug side effects, being on TB treatment, and being off CPT were shortening the time to death. Therefore, efforts have to be made to reduce malnutrition and active-TB/HIV co-infection associated accelerated mortality.

Keywords: lts; Time to death; TB/HIVforecasting

Abbreviations: AHR: Adjusted Hazard Ratio; ART: Anti-Retroviral Therapy; BMI: Body Mass Index; CPT: Co-trimoxazole Preventive Therapy; CHR: Crude Hazard Ratio; CI: Confidence Interval; EPTB: Extra-Pulmonary Tuberculosis; HIV: Human Immunodeficiency; Virus HR: Hazard Ratio; IPT: Isoniazid Preventive Therapy; IQR: Interquartile Range; LTBI: Latent TB Infection; OI/s: Opportunistic Infection; PLWHIV: People Living with HIV; PMs: Person Months; PTB: Pulmonary Tuberculosis; SSA: Sub-Saharan Africa; TB: Tuberculosis; WHO: World Health Organization

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