Modeling Survival Time to Death Among TB and HIV Co-infected Adult Patients: an Institution-Based Retrospective Cohort Study

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

Background

Tuberculosis (TB) is the leading cause of death among HIV-infected adults and children globally. Therefore, this study was aimed at determining the pooled mortality rate and its predictors among TB/HIV-coinfected patients in Ethiopia.

Methods

Extensive database searching was done via PubMed, EMBASE, SCOPUS, ScienceDirect, Google Scholar, and Google from the time of idea conception on March 1, 2023, to the last search via Google on March 31, 2023. A meta-analysis was performed using the random-effects model to determine the pooled mortality rate and its predictors among TB/HIV-coinfected patients. Heterogeneity was handled using subgroup analysis, meta-regression, and sensitivity analysis.

Results

Out of 2,100 records, 18 articles were included, with 26,291 total patients. The pooled incidence rate of mortality among TB/HIV patients was 12.49 (95% CI: 9.24-15.74) per 100 person-years observation (PYO); I2 = 96.9%. The mortality rate among children and adults was 5.10 per 100 PYO (95% CI: 2.15-8.01; I2 = 84.6%) and 15.78 per 100 PYO (95% CI: 10.84-20.73; I2 = 97.7%), respectively. Age ≥ 45 (pooled hazard ratios (PHR) 2.58, 95% CI: 2.00- 3.31), unemployed (PHR 2.17, 95% CI: 1.37-3.46), not HIV-disclosed (PHR = 2.79, 95% CI: 1.65-4.70), bedridden (PHR 5.89, 95% CI: 3.43-10.12), OI (PHR 3.5, 95% CI: 2.16-5.66), WHO stage IV (PHR 3.16, 95% CI: 2.18-4.58), BMI < 18.5 (PHR 4.11, 95% CI: 2.28-7.40), anemia (PHR 4.43, 95% CI: 2.73-7.18), EPTB 5.78, 95% CI: 2.61-12.78 significantly affected the mortality. The effect of TB on mortality was 1.95 times higher (PHR 1.95, 95% CI: 1.19-3.20; I2 = 0) than in TB-free individuals.

Conclusions

The mortality rate among TB/HIV-coinfected patients in Ethiopia was higher compared with many African countries. Many clinical factors were identified as significant risk factors for mortality. Therefore, TB/HIV program managers and clinicians need to design an intervention early.

Predictors for viral load suppression among HIV positive adults under ART treatment in University of Gondar Comprehensive Specialized Hospital: retrospective cohort study

HIV continues to be a serious global public health concern, having 40.4 million lives up to now and continuing to spread throughout all countries. The objective of this study was to identify predictors for viral load suppression among HIV positive adults under ART treatment in University of Gondar Comprehensive Specialized Hospital, Ethiopia. An institution based retrospective cohort study design was carry out from 30th March 2017-30th March 2022.Accelerated failure time model were employed to get wide-ranging information about adult HIV positive patients. In this study out of 378 study participants, about 77.8% were suppressed viral load count and the rest were censored. The Weibull AFT model results revealed that predictors were older age (φ = 0.774, 95% CI 0.602-0.793), primary educators (φ = 0.931, 95% CI 0.809-0.964), patients disclosed the disease to family member (φ = 1.093, 95% CI 1.001-1.457), viral load < 10,000 copies/mL (φ = 1.153, 95% CI 1.015-1.309), hemoglobin level ≥ 11g/dL (φ = 1.145, 95% CI 1.028-1.275), CD4 cell count ≥ 200 per mm3 (φ = 1.147, 95% CI 1.019-1.290), weight ≥ 50 kg (φ = 1.151, 95% CI 1.033-1.275), BMI between 18.5 and 24.9 kg/m3 (φ = 1.143, 95% CI 1.007-1.296), fair treatment adherence (φ = 1.867, 95% CI 1.778-1.967), good treatment adherence (φ = 1.200, 95% CI 1.046-1.377), advanced WHO clinical stages (φ = 0.923, 95% CI 0.899-0.946), patients with OCC (φ = 0.821, 95% CI 0.720-0.936) and substance use (φ = 0.876, 95% CI 0.773-0.993) statistically significant predictors for viral load suppression at 5% level of significance. Then, near intensive care of adult patients' whose ages between 25 and 34 years, primary educational level, advanced WHO clinical stage, patients with OCC, and substance users can help them improve their health and live longer. Lastly, further studies should be done on HIV positive adult patients by considering other important independent variables that were not included in this study.

Survival rate and predictors of mortality among TB/HIV co-infected adult patients: retrospective cohort study

Nowadays, Tuberculosis remains the major cause of HIV-associated mortality, which accounts for 1 out of every 5 HIV-related mortality worldwide. This study aimed to determine the survival rate and predictors of mortality among TB/HIV co-infected patients. An institution-based retrospective cohort study was undertaken on adult TB/HIV co-infected individuals between 1st February 2014 and 30th January 2022 at Mettu Karl Referral Hospital. A Cox regression model was used to identify predictors of survival time to death among TB/HIV co-infected patients. This study comprised 402 TB and HIV co-infected adult patients. Among these, 84 (20.9%) died, and 318 (79.1%) were censored. The study subjects have been followed up for 6920 person-months with an overall median survival time of 17.6 months. The overall incidence rate was 12.1 per 1000 person months [95% CI: 9.77-14.98]. The results of a multivariable Cox regression analysis showed that being at an older age, urban residence, WHO clinical stage II & IV, CD4 count of ≥ 200 cells/mm³, bedridden functional status, using INH, and using CPT were associated with the survival time of TB and HIV co-infected patients at a significance level of alpha = 0.05. This retrospective study found that high mortality of TB/HIV co-infected patients occurred in the earlier months of treatment initiation. Close monitoring of patients with low CD4, who do not utilize CPT, who are in advanced WHO stages, and who have poor functional levels can help them improve their health and live longer.