Increased Mortality in HIV Infected Individuals with Tuberculosis: A Retrospective Cohort Study, Addis Ababa, Ethiopia

Tuberculosis-related deaths at a tertiary hospital in Zambia: Insights into the prevalence and associated factors

Tuberculosis (TB) mortality remains a significant public health concern globally. This study aimed to determine the prevalence of tuberculosis-related deaths and associated factors among patients at Livingstone University Teaching Hospital (LUTH) Chest Clinic, Zambia. We conducted a retrospective cross-sectional study among 694 individuals (507 adult and 187 children) diagnosed with drug susceptible TB disease between January 1, 2021, and December 31, 2022. Demographic and clinical information were collected from medical records using a data collection form. Multivariable logistic regression was used to determine factors associated with TB-related death. Statistical significance was set at p < 0.05. STATA version 15 was used for all data analysis. The prevalence of TB-related death among adults (above 19 years old) was 18.4% (n = 93) whereas that in children (below 19 years old) was 7.0% (n = 187). Living with HIV (AOR 1.75, 95% CI 1.00-3.08, p = 0.049) was positively associated with TB-related death among the adult patients while being on a family based direct observation therapy (DOT) plan was negatively associated with TB-related death both among adults and among children, (AOR 0.24, 95% CI 0.13-0.45, p <0.001) and (AOR 0.2, 95% CI 0.03-0.99, p = 0.039) respectively. This study found a high TB-related mortality rate, both among adults and children, exceeding the national target of 5% and it was significantly associated with HIV status and DOT plan. There is therefore a need to enhance strategies aimed at reducing TB-related deaths, especially among those living with HIV.

Clinical characteristics and mortality of tuberculosis among adults living with HIV/AIDS: A single center, retrospective cohort study in Thailand

BACKGROUND

Tuberculosis (TB) among people living with HIV/AIDS (PLWHA) contributes substantially to morbidity and mortality, particularly in high TB burden countries. Our objective is to investigate the clinical characteristics and mortality rates associated with TB among adult PLWHA over a 10-year period at an urban HIV clinic situated in a high TB burden country.

METHOD

A retrospective cohort study was conducted in 2022. The primary endpoints were clinical characteristics and mortality rate of TB, determined as per 100 person-years among adult PLWHA, presented with a 95% confidence interval. Univariable and multivariable Cox proportional regression analyses were performed to determine risk factors for TB mortality.

RESULT

From January 2012-December 2022, 155 PLWHA receiving a diagnosis of TB were enrolled. The median age was 29 (26.5-48.5) years, and the median CD4 + T cell count was 141 (41.8-252.8) cells/µL, with 60.0% of patients with TB manifesting as disseminated infection. The most involved organs were pulmonary (89.7%), lymph nodes (39.4%) and pleura (14.8%). The treatment outcomes exhibited success in 63.2% of cases, relapse in 5.2%, loss to follow up in 17.4% and death in 14.2%. The overall mortality rate was 18.8 per 100 person-years. Multivariable analyses showed significant factors affecting mortality, including lymph node involvement (adjusted HR 3.5; 95% CI 1.1-10.8) and thrombocytopenia (adjusted HR 74.2; 95% CI 10.0-551.4).

CONCLUSION

TB in PLWHA, commonly presenting as disseminated infection, contributes to high mortality. Lymph node involvement and thrombocytopenia are significant factors contributing to mortality. Tuberculosis preventive treatment should be considered for improved prevention strategies among PLWHA, particularly in high TB burden countries.

Mortality and associated factors among patients with TB-HIV co-infection in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection is a major public health problem in Ethiopia. Patients with TB-HIV co-infection have significantly higher mortality rates compared to those with TB or HIV mono-infection. This systematic review and meta-analysis aim to summarize the evidence on mortality and associated factors among patients with TB-HIV co-infection in Ethiopia.

METHODS

Comprehensive searches were conducted in multiple electronic databases (PubMed/MEDLINE, Embase, CINAHL, Web of Science) for observational studies published between January 2000 and present, reporting mortality rates among TB/HIV co-infected individuals. Two reviewers performed study selection, data extraction, and quality assessment independently. Random-effects meta-analysis was used to pool mortality estimates, and heterogeneity was assessed using I² statistics. Subgroup analyses and meta-regression were performed to explore potential sources of heterogeneity.

RESULTS

185 articles were retrieved with 20 studies included in the final analysis involving 8,113 participants. The pooled mortality prevalence was 16.65% (95% CI 12.57%-19.65%) with I2 : 95.98% & p-value < 0.00. Factors significantly associated with increased mortality included: older age above 44 years (HR: 1.82; 95% CI: 1.31-2.52), ambulatory(HR: 1.64; 95% CI: 1.23-2.18) and bedridden functional status(HR: 2.75; 95% CI: 2.01-3.75), extra-pulmonary Tuberculosis (ETB) (HR: 2.34; 95% CI: 1.76-3.10), advanced WHO stage III (HR: 1.76; 95% CI: 1.22-2.38) and WHO stage IV (HR: 2.17; 95% CI:1.41-3.34), opportunistic infections (HR: 1.75; 95% CI: 1.30-2.34), low CD4 count of < 50 cells/mm3 (HR: 3.37; 95% CI: 2.18-5.22) and lack of co-trimoxazole prophylaxis (HR: 2.15; 95% CI: 1.73-2.65).

CONCLUSIONS

TB/HIV co-infected patients in Ethiopia experience unacceptably high mortality, driven by clinical markers of advanced immunosuppression. Early screening, timely treatment initiation, optimizing preventive therapies, and comprehensive management of comorbidities are imperative to improve outcomes in this vulnerable population.

Tuberculosis-associated mortality and risk factors for HIV-infected population in Ethiopia: a systematic review and meta-analysis

Background

Despite the effectiveness of antiretroviral therapy in reducing mortality from opportunistic infections among people living with HIV (PLHIV), tuberculosis (TB) continues to be a significant cause of death, accounting for over one-third of all deaths in this population. In Ethiopia, there is a lack of comprehensive and aggregated data on the national level for TB-associated mortality during co-infection with HIV. Therefore, this systematic review and meta-analysis aimed to estimate TB-associated mortality and identify risk factors for PLHIV in Ethiopia.

Methods

We conducted an extensive systematic review of the literature using the Preferred Reporting of Systematic Review and Meta-Analysis (PRISMA) guidelines. More than seven international electronic databases were used to extract 1,196 published articles from Scopus, PubMed, MEDLINE, Web of Science, HINARY, Google Scholar, African Journal Online, and manual searching. The pooled mortality proportion of active TB was estimated using a weighted inverse variance random-effects meta-regression using STATA version-17. The heterogeneity of the articles was evaluated using Cochran's Q test and I 2 statistic test. Subgroup analysis, sensitivity analysis, and Egger's regression were conducted to investigate publication bias. This systematic review is registered in Prospero with specific No. CRD42024509131.

Results

Overall, 22 individual studies were included in the final meta-analysis reports. During the review, a total of 9,856 cases of TB and HIV co-infection were screened and 1,296 deaths were reported. In the final meta-analysis, the pooled TB-associated mortality for PLHIV in Ethiopia was found to be 16.2% (95% CI: 13.0-19.2, I 2 = 92.9%, p = 0.001). The subgroup analysis revealed that the Amhara region had a higher proportion of TB-associated mortality, which was reported to be 21.1% (95% CI: 18.1-28.0, I 2 = 84.4%, p = 0.001), compared to studies conducted in Harari and Addis Ababa regions, which had the proportions of 10% (95% CI: 6-13.1%, I 2 = 83.38%, p = 0.001) and 8% (95% CI: 1.1-15, I 2 = 87.6%, p = 0.001), respectively. During the random-effects meta-regression, factors associated with co-infection of mortality in TB and HIV were identified, including WHO clinical stages III & IV (OR = 3.01, 95% CI: 1.9-4.7), missed co-trimoxazole preventive therapy (CPT) (OR = 1.89, 95% CI: 1.05-3.4), and missed isoniazid preventive therapy (IPT) (OR = 1.8, 95% CI: 1.46-2.3).

Conclusion

In Ethiopia, the mortality rate among individuals co-infected with TB/HIV is notably high, with nearly one-fifth (16%) of individuals succumbing during co-infection; this rate is considered to be higher compared to other African countries. Risk factors for death during co-infection were identified; the included studies examined advanced WHO clinical stages IV and III, hemoglobin levels (≤10 mg/dL), missed isoniazid preventive therapy (IPT), and missed cotrimoxazole preventive therapy (CPT) as predictors. To reduce premature deaths, healthcare providers must prioritize active TB screening, ensure timely diagnosis, and provide nutritional counseling in each consecutive visit.

Systematic review registration

Trial registration number in Prospero =CRD42024509131 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=509131.

A retrospective study of tuberculosis prevalence and associated factors among HIV-positive key populations in Nigeria

HIV is a major risk factor for active Tuberculosis (TB.) This raises patients' risk of original infection, reinfection, and TB reactivation. Providing healthcare to KPLHIV in developing countries requires TB prevalence research. This study aims to determine the prevalence of TB and HIV co-infection and associated factors among KPLHIV. This is a retrospective cross-sectional study among KP's living with HIV enrolled on care in One Stop Shop (OSS) of Heartland Alliance Ltd/GTE across six states in Nigeria. Data were analysed using IBM SPSS version 25.0. Secondary data analysis of client's records from the RADET files of the KPCARE 1 project from 6 states was conducted. Means with standard deviations were computed for continuous variables like age, and frequency tables were generated for categorical variables. Chi-square tests and t-tests were used for the bivariate analysis of variables. All tests were done at a 5% level of statistical significance (p = 0.05).TB prevalence was 19.1% among KP's living with HIV, with variations observed in age groups, geographic locations, target populations, marital status, educational backgrounds, clinical characteristics, and antiretroviral therapy (ART) history. KPs aged 51 and above exhibited the highest TB prevalence (21.0%), while those aged below 20 years had the lowest (18.2%). Jigawa KPs recorded the highest TB prevalence (38.4%), and Niger had the least (13.3%). TB was more prevalent among People who inject drugs (20.3%), divorced (32.3%), and those who attained Qur'anic education (29.7%). KPs who had to restart ART exhibited the highest TB prevalence (22.0%), whereas those who experienced Interruption in treatment (IIT) reported the lowest at 10.0%. Immune-suppressed KPs (CD4 counts < 200 cells/m3) had a higher TB prevalence of 26.6%. TB prevalence among KPs living with HIV varies greatly, underlining the need for targeted treatments, especially for high-risk categories, to improve HIV treatment outcomes and reduce TB prevalence.

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.

Patient satisfaction with antiretroviral therapy service provided by pharmacists in Dembia district health institutions, Northwest Ethiopia

BACKGROUND

The patients' perception of the health service is a vital tool for measuring health service quality. Besides, Patient satisfaction is an essential feature in assessing the quality of health services. Health institution leaders are considering quantifiable patient satisfaction data as a means to evaluate the health care service.

METHOD

An institution-based cross-sectional study was employed from 21/8/2022 to 21/9/2022 among 308 patients attending ART pharmacy services in three health institutions of Dembia distinct. Data were collected by using a questionnaire and reviewing medical charts. Results were calculated and presented in the form of texts, tables, and graphs. Variables with a p-value of 0.05 were considered significant determinants of patient satisfaction.

RESULT

A total of 308 HIV patients were recruited with a response rate of 100%. The overall prevalence of satisfaction among respondents was 231(75%). Being unable to read and write [1.21(AOR = 1.07-4.31)] and patient age greater than 48 years 1.9(0.73-2.59) were significantly associated with the level of patient satisfaction. Among the participants 66.9% were satisfied with clear and organized service, and 76% were satisfied with the convenience of a private counseling room.

CONCLUSION

The general patient satisfaction at the antiretroviral therapy clinic did not achieve the national target of 85% satisfaction with significant differences among health centers. Being educated to a higher level, absence of signs and directions to ART clinics, and not having the opportunity to ask questions were the factors influencing patient satisfaction with ART service.

Atypical Pulmonary Tuberculosis as the First Manifestation of Advanced HIV Disease—Diagnostic Difficulties

Tuberculosis (TB) is the leading cause of morbidity, hospitalisations, and mortality in people living with HIV (PLWH). The lower CD4+ T-lymphocyte count in the course of HIV infection, the higher risk of active TB, and the higher odds for atypical clinical and radiologic TB presentation. These HIV-related alterations in TB presentation may cause diagnostic problems in patients not knowing they are infected with HIV. We report on a patient without any background medical conditions, who was referred to a hospital with a 4-month history of chest and feet pains, mild dry cough, fatigue, reduced appetite, and decreasing body weight. Chest X-ray revealed mediastinal lymphadenopathy, bilateral reticulonodular parenchymal opacities, and pleural effusion. A preliminary diagnosis of lymphoma, possibly with a superimposed infection was established. Further differential diagnostic process revealed pulmonary TB in the course of advanced HIV-1 disease, with a CD4+ T-lymphocyte count of 107 cells/mm3. The patient completed anti-tuberculous therapy and successfully continues on antiretroviral treatment. This case underlines the importance of screening for HIV in patients with newly diagnosed TB.