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Chukwuocha IK, Johnson SM, Aguoru EP. Prevalence, Profile and Treatment Outcome of Tuberculosis-Human Immunodeficiency Virus Co-Infection in South Eastern Nigeria: A 3-Year Retrospective Study. Niger Med J 2023; 64:789-798. [PMID: 38979051 PMCID: PMC11227634 DOI: 10.60787/nmj-64-6-372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Background Tuberculosis (TB) and the Human Immune Deficiency Virus (HIV) represent major public health challenges and are intricately linked to each other. This is more prevalent in the sub-Saharan African region, where about 80% of this co-infection is recorded. This study aimed to review the prevalence, profile, and treatment outcome of TB-HIV co-infected patients. Methodology A hospital-based retrospective study was conducted in a tertiary center in southeast Nigeria for the period 2015-2017. Information elicited from participant's medical records included socio-demographic profile (age, sex, residential area, and occupation), Cluster of Differentiation 4 (CD4) count level at the time of diagnosis of co-infection, weight, treatment outcome, as well as the record of the number of TB patients who presented within this same period. Results The total number of TB/HIV co-infected patients who participated in the study during this period was 207, with a prevalence of TB/HIV co-infection of 33.9%. The highest proportion of cases was recorded among participants within the age group of 31-40, and the cases of co-infection were more common in males (58.9%) and students (27.5%). The results also showed a significant relationship between gender, occupation, residential area, and TB/HIV co-infection. Most of the co-infected participants had a CD4 count of <300 cells/mm3 and an associated poor treatment outcome of 41.1%. Conclusions TB/HIV co-infection needs to be properly addressed, and screening for HIV among TB patients should be a priority. This will help in early diagnosis and subsequently improve the treatment outcome of both diseases.
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Affiliation(s)
| | - Simon Mafuka Johnson
- Department of Internal Medicine, Federal University Teaching Hospital Owerri, Owerri, Nigeria
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Wondmeneh TG, Mekonnen AT. The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:613. [PMID: 37723415 PMCID: PMC10507970 DOI: 10.1186/s12879-023-08533-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 08/11/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Tuberculosis, along with HIV, is the leading cause of mortality and morbidity globally. Despite the fact that several primary studies have been conducted on the incidence rate of tuberculosis in HIV-infected people in Sub-Saharan Africa, the regional-level tuberculosis incidence rate remains unknown. The objective of this study is to determine the tuberculosis incidence rate and its associated factors in HIV-infected people in Sub-Saharan Africa. METHODS A systematic review and meta-analysis were conducted by searching four databases for studies published in English between January 1, 2000, and November 25, 2022. The study was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. To assess the quality of the studies, the Joanna Briggs Institute critical appraisal checklist was used. A random-effects model meta-analysis was used to determine the pooled incidence of tuberculosis using STATA version 15. The I2 heterogeneity test was used to assess heterogeneity. Subgroup and sensitivity analyses were performed. Funnel plots and Egger's regression tests were used to investigate publication bias. The pooled estimate predictors of tuberculosis incidence rate with a 95% confidence interval were also determined using the hazard ratio of each factor (HR). RESULTS Out of a total of 3339 studies, 43 were included in the analysis. The overall pooled incidence rate of tuberculosis in HIV-infected people was 3.49 per 100 person-years (95% CI: 2.88-4.17). In the subgroup analysis, the pooled incidence rate of tuberculosis in HIV-infected children was 3.42 per 100 person-years (95% CI: 1.78, 5.57), and it was 3.79 per 100 person-years (95% CI: 2.63, 5.15) in adults. A meta-analysis revealed that underweight (AHR = 1.79, 95% CI: 1.61-1.96), low CD4 count (AHR = 1.23, 95% CI: 1.13-1.35), male gender (AHR = 1.43, 95% CI: 1.22-1.64), advanced WHO clinical stages (AHR = 2.29, 95% CI: 1.34-3.23), anemia (AHR = 1.73, 95% CI: 1.34-2.13), bedridden or ambulatory (AHR = 1.87, 95%), lack of isoniazid preventive therapy (AHR = 3.32, 95% CI: 1.08-2.28), and lack of cotrimoxazole (AHR = 1.68, 95% CI: 1.08-2.28) were risk factors for tuberculosis incidence. HIV patients who received antiretroviral therapy had a 0.53 times higher risk of acquiring tuberculosis than HIV patients who did not receive antiretroviral therapy (AHR = 0.53; 95% CI: 0.3-0.77). CONCLUSION In this systematic review and meta-analysis study, the incidence rate of tuberculosis among HIV-positive people was higher than the WHO 2022 Africa regional estimated report. To reduce the incidence of tuberculosis among HIV patients, HIV patients should take isoniazid prevention therapy (IPT), cotrimoxazole prophylaxis, and antiretroviral therapy (ART) without interruption, as well as increase the frequency and diversity of their nutritional intake. Active tuberculosis screening should be increased among HIV-infected people.
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Affiliation(s)
| | - Ayal Tsegaye Mekonnen
- Department of Biomedical, College of Health Science, Samara University, Samara, Ethiopia
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Bogale B, Asefa A, Destaw A, Midaksa G, Asaye Z, Alemu Gebremichael M, Wolde AA, Yimer E, Yosef T. Determinants of virological failure among patients on first line highly active antiretroviral therapy (HAART) in Southwest Ethiopia: A case-control study. Front Public Health 2022; 10:916454. [PMID: 36408009 PMCID: PMC9667891 DOI: 10.3389/fpubh.2022.916454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 09/26/2022] [Indexed: 01/22/2023] Open
Abstract
Background Virological failure remains a public health concern among patients with human immunodeficiency virus (HIV) after treatment initiation. Ethiopia is one of the countries that aims to achieve the global target of 90-90-90 that aims to achieve 90% virological suppression, but there is a paucity of evidence on the determinants of virological failure. Therefore, the study is intended to assess determinants of virological treatment failure among patients on first-line highly active antiretroviral therapy (HAART) at Mizan Tepi University Teaching Hospital (MTUTH), Southwest Ethiopia. Method A hospital-based unmatched case-control study was conducted from 11 November to 23 December 2020, among 146 cases and 146 controls. All cases and controls were selected randomly using computer-generated random numbers based on their medical record numbers. During the document review, data were collected using checklists, entered into Epi-data version 4.0.2, and analyzed by SPSS version 25. A multivariable logistic regression analysis was done to identify the independent determinants of virological treatment failure. Results In this study, being male (adjusted odds ratio (AOR) = 1.89, 95% CI: 1.04, 3.47), substance use (AOR = 2.67, 95% CI: 1.40, 4.95), baseline hemoglobin (Hgb) < 12 mg/dl (AOR = 3.22, 95% CI: 1.82, 5.99), poor drug adherence (AOR = 3.84, 95% CI: 1.77, 5.95), restart ART medication (AOR = 2.45, 95% CI: 1.69, 7.35), and opportunistic infection (OI) while on HAART (AOR = 4.73, 95% CI: 1.76, 12.11) were determinants of virological treatment failure. Conclusion The study revealed that the sex of the patient, history of substance use, baseline Hgb < 12 mg/dl, poor drug adherence, restart after an interruption, and having OI through the follow-up period were determinants of virological failure. Therefore, program implementation should consider gender disparity while men are more prone to virological failure. It is also imperative to implement targeted interventions to improve drug adherence and interruption problems in follow-up care. Moreover, patients with opportunistic infections and restart HAART need special care and attention.
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Affiliation(s)
- Biruk Bogale
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia,*Correspondence: Biruk Bogale ;
| | - Adane Asefa
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Alemnew Destaw
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Gachana Midaksa
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Zufan Asaye
- Department of Statistics, College of Natural Sciences, Mizan-Tepi University, Tepi, Ethiopia
| | - Mathewos Alemu Gebremichael
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Asrat Arja Wolde
- Department of Data Repository and Governance, National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ejig Yimer
- Department of Public Health, Mizan-Aman Health Science College, Mizan-Aman, Ethiopia
| | - Tewodros Yosef
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Kiros T, Taye A, Workineh L, Eyayu T, Damtie S, Hailemichael W, Tiruneh T. Immuno-virological status and its associated factors among HIV-positive patients receiving highly active antiretroviral therapy at delgi primary hospital, northwest Ethiopia, 2020/2021: A cross-sectional study. Heliyon 2022; 8:e10169. [PMID: 36033289 PMCID: PMC9399164 DOI: 10.1016/j.heliyon.2022.e10169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 03/17/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Highly active antiretroviral therapy (HAART) improves clinical outcomes by suppressing viral replication and allowing immune reconstitution. It also reduces HIV-related complications including morbidity, mortality, and extended hospitalizations for HIV-positive individuals. Regular assessment for antiretroviral treatment response is fundamentally important to address the factors associated with the poor clinical outcome including immunologic failures among HIV-positive patients on HAART. Therefore, this study aimed to investigate the immuno-virological status and describe its determinants among HIV-positive patients receiving HAART at Delgi primary hospital, Northwest Ethiopia. Methods A hospital-based cross-sectional study was conducted at Delgi primary hospital from October 25th through June 19th 2021 among a total of 442 study participants. A systematic random sampling technique was employed to enrol participants in the study. Socio-demographic and clinically related data were collected using a semi-structured questionnaire. About 3–5 ml of venous blood was collected aseptically for CD4+ T cell count and viral load test. SPSS version 20 software was used for statistical analysis. Bivariate and multivariate logistic regression analyses were conducted to determine the factors associated with immuno-virologic status among HIV-positive patients on HAART. The odds ratio with 95% CI was computed to determine the strength of association. Then, a p-value < 0.05 was considered a statistically significant association. For this study, the results were presented by using frequency summary tables, and texts. Results Among the total study participants, 283 (64%) were males and the mean age of the study participants was 37 ± 11.5. The overall immunological and virological failure among highly active antiretroviral therapy (HAART) receiving participants was found to be 9.5% (42/442, 95%CI:3.23–15.09) and 12.2% (54/442, 95% CI: 2.81–23.04) respectively. In the multivariate analysis, study participants with age ≥50 years old [AOR = 1.97, p = 0.01, 95%CI (0.02–4.03)], participants having current viral load count greater ≥1000 copies/ml [AOR = 3.97, p = 0.03, 95%CI (1.09–5.01)] and having TB-co-infection [AOR = 2.51, p = 0.05, 95%CI (1.02–7.51)] were statistically associated with increased risk of immunological failure. Similarly, TB-coinfected participants were 1.88 (95%CI = 0.89–10.02) times at greater risk for virological failure. Conclusion In this study, the magnitude of immuno-virological failure is alarming. This may be shown the need for integrated and substantial commitment to enhancing patient antiretroviral treatment adherence in the study area. Also, regular assessment for antiretroviral treatment response is fundamentally important to address the determinants associated with virological and immunologic failures among HIV-positive patients taking HAART. Furthermore, early initiation of HAART may be imperative to achieve favourable virological suppression and immunological reconstitution.
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Affiliation(s)
- Teklehaimanot Kiros
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebe Taye
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Lemma Workineh
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tahir Eyayu
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shewaneh Damtie
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wasihun Hailemichael
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
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Folayan MO, Ibigbami O, Brown B, El Tantawi M, Uzochukwu B, Ezechi OC, Aly NM, Abeldaño GF, Ara E, Ayanore MA, Ayoola OO, Osamika BE, Ellakany P, Gaffar B, Idigbe I, Ishabiyi AO, Jafer M, Khan ATA, Khalid Z, Lawal FB, Lusher J, Nzimande NP, Popoola BO, Quadri MFA, Rashwan M, Roque M, Shamala A, Al-Tammemi AB, Yousaf MA, Abeldaño Zuñiga RA, Okeibunor JC, Nguyen AL. Differences in COVID-19 Preventive Behavior and Food Insecurity by HIV Status in Nigeria. AIDS Behav 2022; 26:739-751. [PMID: 34387776 PMCID: PMC8360820 DOI: 10.1007/s10461-021-03433-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 01/21/2023]
Abstract
The aim of the study was to assess if there were significant differences in the adoption of COVID-19 risk preventive behaviors and experience of food insecurity by people living with and without HIV in Nigeria. This was a cross-sectional study that recruited a convenience sample of 4471 (20.5% HIV positive) adults in Nigeria. Binary logistic regression analysis was conducted to test the associations between the explanatory variable (HIV positive and non-positive status) and the outcome variables-COVID-19 related behavior changes (physical distancing, isolation/quarantine, working remotely) and food insecurity (hungry but did not eat, cut the size of meals/skip meals) controlling for age, sex at birth, COVID-19 status, and medical status of respondents. Significantly fewer people living with HIV (PLWH) reported a positive COVID-19 test result; and had lower odds of practicing COVID-19 risk preventive behaviors. In comparison with those living without HIV, PLWH had higher odds of cutting meal sizes as a food security measure (AOR: 3.18; 95% CI 2.60-3.88) and lower odds of being hungry and not eating (AOR: 0.24; 95% CI 0.20-0.30). In conclusion, associations between HIV status, COVID-19 preventive behaviors and food security are highly complex and warrant further in-depth to unravel the incongruities identified.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | | | - Brandon Brown
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, UCR School of Medicine, Riverside, CA, USA
| | - Maha El Tantawi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Benjamin Uzochukwu
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Community Medicine, University of Nigeria Nsukka (Enugu Campus), Nsukka, Nigeria
| | - Oliver C Ezechi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Nourhan M Aly
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Giuliana Florencia Abeldaño
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- School of Medicine, University of Sierra Sur, Oaxaca, Mexico
| | - Eshrat Ara
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Psychology, Government College for Women, Moulana Azad Road, Srinagar, Kashmir (J&K), 190001, India
| | - Martin Amogre Ayanore
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana
| | - Oluwagbemiga O Ayoola
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Radiology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Bamidele Emmanuel Osamika
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Psychology, Lead City University, Ibadan, Nigeria
| | - Passent Ellakany
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Balgis Gaffar
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Ifeoma Idigbe
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Anthonia Omotola Ishabiyi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mohammed Jafer
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Health Promotion, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Abeedha Tu-Allah Khan
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- School of Biological Sciences, University of the Punjab, Quaid-i-Azam Campus, Lahore, 54590, Pakistan
| | - Zumama Khalid
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- School of Biological Sciences, University of the Punjab, Lahore, 54590, Pakistan
| | - Folake Barakat Lawal
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Periodontology and Community Dentistry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joanne Lusher
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- School of Health and Life Sciences, University of the West of Scotland, London, UK
| | - Ntombifuthi P Nzimande
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Economic and Human Geography, University of Szeged, Szeged, 6722, Hungary
| | - Bamidele Olubukola Popoola
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Child Oral Health, University of Ibadan, Ibadan, Nigeria
| | - Mir Faeq Ali Quadri
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Preventive Dental Sciences, Jazan University, Jizan, Saudi Arabia
| | - Maher Rashwan
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Centre for Oral Bioengineering, Barts and the London, School of Medicine and Dentistry, Queen Mary University of London, Mile End Road, London, E1 4NS, UK
- Department of Conservative Dentistry, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mark Roque
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Maternity & Childhood Department, College of Nursing, Taibah University, Madinah, 42356, Kingdom of Saudi Arabia
| | - Anas Shamala
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Preventive and Biomedical Science, College of Dentistry, University of Science & Technology, Sanaa, Yemen
| | - Ala'a B Al-Tammemi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Family and Occupational Medicine, Faculty of Medicine, Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Muhammad Abrar Yousaf
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Institute of Zoology, University of the Punjab, Quaid-i-Azam Campus, Lahore, 54590, Pakistan
| | - Roberto Ariel Abeldaño Zuñiga
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Postgraduate Department, University of Sierra Sur, Oaxaca, Mexico
| | - Joseph Chukwudi Okeibunor
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- World Health Organisation, AFRO, Addis Ababa, Ethiopia
| | - Annie Lu Nguyen
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Nasomsong W, Phokaphol K, Changpradub D. First-Line Antiretroviral Regimen Failure and Determinants in an Urban HIV Clinic at Phramongkutklao Hospital, Bangkok, Thailand: 20 Years Experience. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:261-269. [PMID: 33692637 PMCID: PMC7939509 DOI: 10.2147/hiv.s295512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/26/2021] [Indexed: 11/23/2022]
Abstract
Purpose HIV treatment involves antiretroviral therapy (ART) endeavoring to suppress viral load to an undetectable level. Virologic failure occurs when ART fails to suppress and sustain an individual’s viral load to less than 200 copies/mL after 6 months of therapy. In Thailand, the data among first-line antiretroviral regimen failure and determinants remains limited, especially in urban HIV clinics. We aimed to demonstrate factors of first-line antiretroviral regimen failures in an urban HIV/AIDS clinic at Phramongkutklao Hospital. Patients and Methods A nested case control 1:4 study was conducted. Data were collected from the electronic patient database among naïve people living with HIV/AIDS (PLWHA), aged ≥18 years and receiving ART continuously for at least 2 years at Phramongkutklao Hospital from 1 January 2000 to 31 December 2019. Multiple logistic regression was used to identify the determinants of virologic failure. Adjusted HRs (AHRs) with 95% CIs were used to declare statistical significance. Results Of 200 PLWHA included in the study, 40 participants experienced HIV virologic failure. The median time after starting ART to virologic failure was 24 months (IQR 7–96.0). Univariate and multivariate analysis showed significant factors affecting first-line antiretroviral regimen failure included being female (37.5 vs 26.88%, adjusted odds ratio 5.08 [1.05–24.6, p-value 0.043], age ≤40 yr. (62.5 vs 49.6%, adjusted odds ratio 4.59 [1.47–14.37], p-value 0.009), CD4+count ≤200 cell/µL (77.5 vs 52.5%, adjusted odds ratio 4.83 [1.28–18.9], p value 0.02), tuberculosis (42.5 vs 7.5%, adjusted odds ratio 8.66 [2.37–31.56], p value <0.001) and initiation of ART at CD4+ count <350 cell/µL (72.5 vs 48.13%, adjusted odds ratio 31.36 [6.51–151.22], p value <0.001). Estimated prevalence of virologic failure in Phramongkutklao Hospital was 5.34%. Conclusion Our study revealed factors favoring virologic failure included being female, younger age, CD4+ count <200 cells/µL, tuberculosis and initiation of ART at CD4+ count <350 cell/µL. Multidisciplinary HIV comprehensive care teams should encourage patient adherence and support patients along HIV continuum of care to prevent virologic failure and drug resistance, especially among patients initiating ART at low CD4+ count and tuberculosis co-infection.
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Affiliation(s)
- Worapong Nasomsong
- Division of Infectious Diseases, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Kwonchit Phokaphol
- Division of Infectious Diseases, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Dhitiwat Changpradub
- Division of Infectious Diseases, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand
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Coinfecção tuberculose/HIV: perfil sociodemográfico e saúde de usuários de um centro especializado. ACTA PAUL ENFERM 2020. [DOI: 10.37689/acta-ape/2020ao00515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Negash H, Legese H, Tefera M, Mardu F, Tesfay K, Gebresilasie S, Fseha B, Kahsay T, Gebrewahd A, Berhe B. The effect of tuberculosis on immune reconstitution among HIV patients on highly active antiretroviral therapy in Adigrat general hospital, eastern Tigrai, Ethiopia; 2019: a retrospective follow up study. BMC Immunol 2019; 20:45. [PMID: 31805857 PMCID: PMC6896417 DOI: 10.1186/s12865-019-0327-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Ethiopia initiated antiretroviral therapy early in 2005. Managing and detecting antiretroviral treatment response is important to monitor the effectiveness of medication and possible drug switching for low immune reconstitution. There is less recovery of CD4+ T cells among human immunodeficiency virus patients infected with tuberculosis. Hence, we aimed to assess the effect of tuberculosis and other determinant factors of immunological response among human immunodeficiency virus patients on highly active antiretroviral therapy. A retrospective follow up study was conducted from October to July 2019. A total of 393 participants were enrolled. An interviewer based questionnaire was used for data collection. Patient charts were used to extract clinical data and follow up results of the CD4+ T cell. Current CD4+ T cell counts of patients were performed. STATA 13 software was used to analyze the data. A p-value ≤0.05 was considered a statistically significant association. Results The mean age of study participants was 39.2 years (SD: + 12.2 years) with 8.32 mean years of follow up. The overall prevalence of immune reconstitution failure was 24.7% (97/393). Highest failure rate occurred within the first year of follow up time, 15.7 per 100 Person-year. Failure of CD4+ T cells reconstitution was higher among tuberculosis coinfected patients (48.8%) than mono-infected patients (13.7%). Living in an urban residence, baseline CD4+ T cell count ≤250 cells/mm3, poor treatment adherence and tuberculosis infection were significantly associated with the immunological failure. Conclusions There was a high rate of CD4+ T cells reconstitution failure among our study participants. Tuberculosis infection increased the rate of failure. Factors like low CD4+ T cell baseline count, poor adherence and urban residence were associated with the immunological failure. There should be strict monitoring of CD4+ T cell counts among individuals with tuberculosis coinfection.
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Affiliation(s)
- Hadush Negash
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia.
| | - Haftom Legese
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Mebrahtu Tefera
- Unit of Quality assurance, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Fitsum Mardu
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Kebede Tesfay
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Senait Gebresilasie
- Unit of Pediatrics and child health, Department of Midwifery, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Berhane Fseha
- Department of Public Health, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia
| | - Tsega Kahsay
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Aderajew Gebrewahd
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Brhane Berhe
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
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9
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Adetunji SO, Donbraye E, Ekong MJ, Adetunji BI. Rifampicin-resistant tuberculosis among known HIV-infected patients in Oyo State, Nigeria. J Immunoassay Immunochem 2019; 40:289-299. [PMID: 30835618 DOI: 10.1080/15321819.2019.1583579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A major opportunistic infection among HIV-infected people is tuberculosis (TB). It accelerates the deadly progression of HIV which results in further decline in the patient's immune status and early death. More than 9 million people suffer from this debilitating coinfection worldwide. More worrisome is the fact that some patients now develop resistance to rifampicin, a first-line drug against TB. This study therefore aimed at determining the rifampicin-resistant TB prevalence rate among known HIV-positive patients in Oyo State. This cross-sectional study was performed by collecting suitable sputum samples from 397 known HIV patients who attended ART Clinic between January and December 2017. The samples were analyzed using the GeneXpert machine, a real-time polymerase chain reaction-based equipment. Of the total 397 tested, 172 (43.3%) were male while 225 (56.7%) were females. Fifty (12.6%) of the 397 known HIV patients tested positive to TB and 6 (12%) of the 50 were resistant to rifampicin. Four (2.3%) of the 172 males had rifampicin-resistant TB and 2 (0.9%) of the 225 females were resistant to rifampicin. Age group 31-40 years was the most affected with pulmonary TB while age group 10-20 years was the most affected with rifampicin-resistant TB. Six (1.5%) of the total 397 were rifampicin resistant. In conclusion, strict compliance with the infection control measures is strongly advocated for to prevent further transmission of Mycobacterium tuberculosis to people living with HIV most of whom have their immune system already weakened.
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Affiliation(s)
- Stephen Oluwasegun Adetunji
- a Medical Microbiology and Parasitology, College of Health Sciences , Obafemi Awolowo University , Ile-Ife , Nigeria.,b Laboratory Department , St Mary's Catholic General Hospital , Ibadan , Nigeria
| | - Emmanuel Donbraye
- a Medical Microbiology and Parasitology, College of Health Sciences , Obafemi Awolowo University , Ile-Ife , Nigeria
| | - Michael Joshua Ekong
- b Laboratory Department , St Mary's Catholic General Hospital , Ibadan , Nigeria
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10
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Okonko IO, Anyanwu A, U Osadebe A, N Odu N. HIV and tuberculosis co-infection in a highly HIV-infected population of rivers state, Nigeria. J Immunoassay Immunochem 2018; 39:636-646. [PMID: 30296205 DOI: 10.1080/15321819.2018.1529681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Human Immunodeficiency Virus (HIV) and tuberculosis (TB) are considered as key players in the global health scene. This study sought to determine the prevalence of TB among HIV-positive attendees of the Directly Observed Treatment of Short Course (DOTS) program at the military hospital in Port Harcourt. The association of HIV prevalence with gender and age as risk factors was also determined. A total of 200 patients aged 15-65 years were screened. Re-screening for HIV was done for confirmation. The overall prevalence for anti-TB antibodies amongst HIV-positive individuals was 14.0% (7.5% in males and 6.5% in females) while HIV prevalence following re-screening was 92%. It was observed that based on employment status and level of education, the highest HIV prevalence was seen in unemployed individuals and individuals with no formal education. The result showed that 29.9% of the HIV seropositives were males while 70.1% were females. Sex-related prevalence of HIV-TB coinfection within groups indicated significantly higher co-infection rates (P < 0.05) among males (23.1%) than females (9.6%). Age-related prevalence of HIV-TB coinfection within groups showed that co-infection was significantly greater (P < 0.05) in ages below 30 years (21.2%) than in their counterparts 30 years and above (9.6%). This study confirmed the presence of TB co-infections among HIV-positive individuals in Port Harcourt, Nigeria. Considering the role of TB in driving the HIV pandemic, it is imperative that HIV-positive patients are screened for TB infection regularly to reduce the scale of active HIV-TB co-infection.
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Affiliation(s)
- Iheanyi O Okonko
- a Department of Microbiology, Faculty of Science , University of Port Harcourt , Choba , Nigeria
| | - Amaoge Anyanwu
- b Department of Microbiology Technology , School of Science Laboratory Technology, University of Port Harcourt , Choba , Nigeria
| | - Anwuli U Osadebe
- a Department of Microbiology, Faculty of Science , University of Port Harcourt , Choba , Nigeria
| | - Ngozi N Odu
- a Department of Microbiology, Faculty of Science , University of Port Harcourt , Choba , Nigeria
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11
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Hailu GG, Hagos DG, Hagos AK, Wasihun AG, Dejene TA. Virological and immunological failure of HAART and associated risk factors among adults and adolescents in the Tigray region of Northern Ethiopia. PLoS One 2018; 13:e0196259. [PMID: 29715323 PMCID: PMC5929526 DOI: 10.1371/journal.pone.0196259] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/09/2018] [Indexed: 12/01/2022] Open
Abstract
Background Human immunodeficiency virus/Acquired immunodeficiency syndrome associated morbidity and mortality has reduced significantly since the introduction of highly active antiretroviral therapy. As a result of increasing access to highly active antiretroviral therapy, the survival and quality of life of the patients has significantly improved globally. Despite this promising result, regular monitoring of people on antiretroviral therapy is recommended to ensure whether there is an effective treatment response or not. This study was designed to assess virological and immunological failure of highly active antiretroviral therapy users among adults and adolescents in the Tigray region of Northern Ethiopia, where scanty data are available. Methods A retrospective follow up study was conducted from September 1 to December 30, 2016 to assess the magnitude and factors associated with virological and immunological failure among 260 adults and adolescents highly active antiretroviral therapy users who started first line ART between January 1, 2008 to March 1, 2016. A standardized questionnaire was used to collect socio-demographic and clinical data. SPSS Version21 statistical software was used for analysis. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated to virological and immunological failure. Statistical association was declared significant if p-value was ≤ 0.05. Result A total of 30 (11.5%) and 17 (6.5%) participants experienced virological and immunological failure respectively in a median time of 36 months of highly active antiretroviral therapy. Virological failure was associated with non-adherence to medications, aged < 40 years old, having CD4+ T-cells count < 250 cells/μL and male gender. Similarly, immunological failure was associated with non-adherence, tuberculosis co-infection and Human immunodeficiency virus RNA ≥1000 copies/mL. Conclusions The current result shows that immunological and virological failure is a problem in a setting where highly active antiretroviral therapy has been largely scale up. The problem is more in patients with poor adherence. This will in turn affect the global targets of 90% viral suppression by 2020. This may indicate the need for more investment and commitment to improving patient adherence in the study area.
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Affiliation(s)
- Genet Gebrehiwet Hailu
- College of Health Sciences, Department of Medical Microbiology and Immunology, Mekelle University, Mekelle, Tigray, Ethiopia
- College of Health Sciences, Ayder Comprehensive Specialized Hospital, Department of Laboratory Mekelle University, Mekelle, Tigray, Ethiopia
| | - Dawit Gebregziabher Hagos
- College of Health Sciences, Department of Medical Microbiology and Immunology, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Amlsha Kahsay Hagos
- College of Health Sciences, Department of Medical Microbiology and Immunology, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Araya Gebreyesus Wasihun
- College of Health Sciences, Department of Medical Microbiology and Immunology, Mekelle University, Mekelle, Tigray, Ethiopia
- * E-mail: ,
| | - Tsehaye Asmelash Dejene
- College of Health Sciences, Department of Medical Microbiology and Immunology, Mekelle University, Mekelle, Tigray, Ethiopia
- College of Health Sciences, Department of Medical Microbiology, Axum University, Tigray, Ethiopia
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12
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Mugomeri E, Bekele BS, Maibvise C, Tarirai C. Trends in diagnostic techniques and factors associated with tuberculosis treatment outcomes in Lesotho, 2010–2015. S Afr J Infect Dis 2018. [DOI: 10.1080/23120053.2017.1376545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Eltony Mugomeri
- Faculty of Health Sciences, Department of Pharmacy, National University of Lesotho, Maseru, Lesotho
| | - Bisrat S Bekele
- Faculty of Health Sciences, Department of Pharmacy, National University of Lesotho, Maseru, Lesotho
| | - Charles Maibvise
- Faculty of Health Sciences, Department of Nursing, University of Swaziland, Mbabane, Swaziland
| | - Clemence Tarirai
- Department of Pharmaceutical Sciences, Tshwane University of Technology, Pretoria, South Africa
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13
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Senghore M, Otu J, Witney A, Gehre F, Doughty EL, Kay GL, Butcher P, Salako K, Kehinde A, Onyejepu N, Idigbe E, Corrah T, de Jong B, Pallen MJ, Antonio M. Whole-genome sequencing illuminates the evolution and spread of multidrug-resistant tuberculosis in Southwest Nigeria. PLoS One 2017; 12:e0184510. [PMID: 28926571 PMCID: PMC5604961 DOI: 10.1371/journal.pone.0184510] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/27/2017] [Indexed: 11/18/2022] Open
Abstract
Nigeria has an emerging problem with multidrug-resistant tuberculosis (MDR-TB). Whole-genome sequencing was used to understand the epidemiology of tuberculosis and genetics of multi-drug resistance among patients from two tertiary referral centers in Southwest Nigeria. In line with previous molecular epidemiology studies, most isolates of Mycobacterium tuberculosis from this dataset belonged to the Cameroon clade within the Euro-American lineage. Phylogenetic analysis showed this clade was undergoing clonal expansion in this region, and suggests that it was involved in community transmission of sensitive and multidrug-resistant tuberculosis. Five patients enrolled for retreatment were infected with pre-extensively drug resistant (pre-XDR) due to fluoroquinolone resistance in isolates from the Cameroon clade. In all five cases resistance was conferred through a mutation in the gyrA gene. In some patients, genomic changes occurred in bacterial isolates during the course of treatment that potentially led to decreased drug susceptibility. We conclude that inter-patient transmission of resistant isolates, principally from the Cameroon clade, contributes to the spread of MDR-TB in this setting, underscoring the urgent need to curb the spread of multi-drug resistance in this region.
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MESH Headings
- Adolescent
- Adult
- Antitubercular Agents/pharmacology
- Bacterial Proteins/genetics
- Cameroon/epidemiology
- Child
- Child, Preschool
- DNA Gyrase/genetics
- Drug Resistance, Multiple, Bacterial/drug effects
- Drug Resistance, Multiple, Bacterial/genetics
- Female
- Genome, Bacterial
- Humans
- Infant
- Infant, Newborn
- Male
- Mutation
- Mycobacterium tuberculosis/classification
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/isolation & purification
- Nigeria/epidemiology
- Phylogeny
- Sequence Analysis, DNA
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/epidemiology
- Tuberculosis, Multidrug-Resistant/microbiology
- Young Adult
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Affiliation(s)
- Madikay Senghore
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia
- Microbiology and Infection Unit, The University of Warwick, Coventry, United Kingdom
| | - Jacob Otu
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - Adam Witney
- Institute of Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Florian Gehre
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Emma L. Doughty
- Microbiology and Infection Unit, The University of Warwick, Coventry, United Kingdom
| | - Gemma L. Kay
- Microbiology and Infection Unit, The University of Warwick, Coventry, United Kingdom
| | - Phillip Butcher
- Institute of Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Kayode Salako
- Department of Medical Microbiology & Parasitology, University College Hospital, Ibadan, Nigeria
| | - Aderemi Kehinde
- Department of Medical Microbiology & Parasitology, University College Hospital, Ibadan, Nigeria
| | - Nneka Onyejepu
- National Tuberculosis Reference Laboratory, Nigeria Institute of Medical Research, Lagos, Nigeria
| | - Emmanuel Idigbe
- National Tuberculosis Reference Laboratory, Nigeria Institute of Medical Research, Lagos, Nigeria
| | - Tumani Corrah
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia
| | | | - Mark J. Pallen
- Microbiology and Infection Unit, The University of Warwick, Coventry, United Kingdom
- Quadram Institute, Norwich Research Park, Norwich, Norfolk, NR4 7UA
| | - Martin Antonio
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia
- Microbiology and Infection Unit, The University of Warwick, Coventry, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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14
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Tachbele E, Ameni G. Survival and predictors of mortality among human immunodeficiency virus patients on anti-retroviral treatment at Jinka Hospital, South Omo, Ethiopia: a six years retrospective cohort study. Epidemiol Health 2016; 38:e2016049. [PMID: 27820957 PMCID: PMC5309728 DOI: 10.4178/epih.e2016049] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/06/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The survival rate of human immunodeficiency virus (HIV)-infected patients receiving treatment in Ethiopia is poorly understood. This study aimed to determine the survival rate and predictors of mortality among HIV-infected adults on antiretroviral therapy (ART) at Jinka Hospital, South Omo, Ethiopia. METHODS A 6-year retrospective cohort study was conducted using 350 patient records drawn from 1,899 patients on ART at Jinka Hospital from September 2010 to August 2015. The data were analyzed using Kaplan-Meier statistics and Cox regression models. RESULTS Of the 350 study participants, 315 (90.0%) were censored and 35 (10.0%) died. Twenty-two (62.9%) of the deaths occurred during the first year of treatment. The total follow-up encompassed 1,995 person-years, with an incidence rate of 1.75 deaths per 100 person-years. The mean survival time of patients on highly active antiretroviral therapy (HAART) was 30.84±19.57 months. The overall survival of patients on HAART was 64.00% (95% confidence interval [CI], 61.85 to 66.21%) at 72 months of follow-up. The significant predictors of mortality included non-disclosure of HIV status (adjusted hazard ratio [aHR], 5.82; 95% CI, 1.91 to 17.72), a history of tuberculosis (aHR, 1.82; 95% CI, 1.41 to 3.51), and ambulatory (aHR, 2.97; 95% CI, 1.20 to 8.86) or bedridden (aHR, 4.67; 95% CI, 1.30 to 17.27) functional status, World Health Organization (WHO) clinical stage IV illness (aHR, 24.97; 95% CI, 2.75 to 26.45), and substance abusers (aHR, 3.72; 95% CI, 1.39 to 9.97). CONCLUSIONS Patients with a history of tuberculosis treatment, ambulatory or bedridden functional status, or advanced WHO clinical stage disease, as well substance abusers, should be carefully monitored, particularly in the first few months after initiating antiretroviral therapy. Patients should also be encouraged to disclose their status to their relatives.
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Affiliation(s)
- Erdaw Tachbele
- Department of Nursing and Midwifery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Gobena Ameni
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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15
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Chang CA, Meloni ST, Eisen G, Chaplin B, Akande P, Okonkwo P, Rawizza HE, Tchetgen Tchetgen E, Kanki PJ. Tuberculosis Incidence and Risk Factors Among Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy in a Large HIV Program in Nigeria. Open Forum Infect Dis 2015; 2:ofv154. [PMID: 26613097 PMCID: PMC4654399 DOI: 10.1093/ofid/ofv154] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/09/2015] [Indexed: 12/18/2022] Open
Abstract
Background. Despite the benefits of antiretroviral therapy (ART), tuberculosis (TB) is the leading cause of mortality among human immunodeficiency virus (HIV)-infected persons in Africa. Nigeria bears the highest TB burden in Africa and second highest HIV burden globally. This long-term multicenter study aimed to determine the incidence rate and predictors of TB in adults in the Harvard/AIDS Prevention Initiative in Nigeria (APIN) and President's Emergency Plan for AIDS Relief (PEPFAR) Nigeria ART program. Methods. This retrospective evaluation used data collected from 2004 to 2012 through the Harvard/APIN PEPFAR program. Risk factors for incident TB were determined using multivariate Cox proportional hazards regression with time-dependent covariates. Results. Of 50 320 adults enrolled from 2005 to 2010, 11 092 (22%) had laboratory-confirmed active TB disease at ART initiation, and 2021 (4%) developed active TB after commencing ART. During 78 228 total person-years (PY) of follow-up, the TB incidence rate was 25.8 cases per 1000 PY (95% confidence interval [CI], 24.7-27.0) overall, and it decreased significantly both with duration on ART and calendar year. Risk factors at ART initiation for incident TB included the following: earlier ART enrollment year, tenofovir-containing initial ART regimen, and World Health Organization clinical stage above 1. Time-updated risk factors included the following: low body mass index, low CD4(+) cell count, unsuppressed viral load, anemia, and ART adherence below 80%. Conclusions. The rate of incident TB decreased with longer duration on ART and over the program years. The strongest TB risk factors were time-updated clinical markers, reinforcing the importance of consistent clinical and laboratory monitoring of ART patients in prompt diagnosis and treatment of TB and other coinfections.
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Affiliation(s)
| | | | - Geoffrey Eisen
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Beth Chaplin
- Departments ofImmunology and Infectious Diseases
| | | | | | - Holly E. Rawizza
- Departments ofImmunology and Infectious Diseases
- Brigham and Women's Hospital, Boston, Massachusetts
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