Early Mortality during Initial Treatment of Tuberculosis in Patients Co-Infected with HIV at the Yaoundé Central Hospital, Cameroon: An 8-Year Retrospective Cohort Study (2006-2013).

Jean Joel R Bigna,André Patrick R Ayong,Jean Jacques N Noubiap,Ako A Agbor,Claudia S Plottel,Serge Clotaire Billong,Sinata Koulla-Shiro,Lei Gao

doi:10.1371/journal.pone.0132394

Abstract

BackgroundUnderstanding contributors to mortality during the initial phase of tuberculosis (TB) treatment in patients co-infected with HIV would guide targeted interventions to improve survival. The aim of this study was to ascertain the incidence of death during the initial 2 months (new cases) and 3 months (retreatment cases) of TB treatment and to assess correlates of mortality in HIV co-infected patients.MethodsWe conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify co-infected TB/HIV inpatients aged 15 years and older who died during TB treatment. Death was defined as any death occurring during TB treatment, as per World Health Organization recommendations. We collected socio-demographic, clinical and laboratory data. We conducted multivariable logistic binary regression analysis to identify factors associated with death during the intensive phase of TB treatment. Magnitudes of associations were expressed by adjusted odds ratio (aOR) with 95% confidence interval. A p value < 0.05 was considered statistically significant.ResultsThe 99 patients enrolled had a mean age of 39.5 (standard deviation 10.9) years and 53% were male. Patients were followed for 276.3 person-months of observation (PMO). Forty nine patients were died during intensive phase of TB treatment. Death incidence during the intensive phase of TB treatment was 32.2 per 100 PMO. Having a non-AIDS comorbidity (aOR 2.47, 95%CI 1.22-5.02, p = 0.012), having extra-pulmonary TB (aOR 1.89, 95%CI 1.05-3.43, p = 0.035), and one year increase in duration of known HIV infection (aOR 1.23, 95%CI 1.004-1.49) were independently associated with death during the intensive phase of TB treatment.ConclusionsMortality incidence during intensive phase of TB treatment was high among TB/HIV co-infected patients during TB treatment; and strongly associated with extra pulmonary TB suggesting advanced stage of immunosuppression and non-AIDS comorbidities. Early HIV diagnosis and care and good management of non-comorbidities can reduce this incidence.

Highlights

Tuberculosis (TB) remains the most common serious opportunistic infection in people infected with human immunodeficiency virus (HIV) in sub-Saharan Africa and is the leading cause of death [1,2,3,4,5]
Patients were followed for 276.3 person-months of observation (PMO)
Forty nine patients were died during intensive phase of TB treatment

Summary

Introduction

Tuberculosis (TB) remains the most common serious opportunistic infection in people infected with human immunodeficiency virus (HIV) in sub-Saharan Africa and is the leading cause of death [1,2,3,4,5]. We are not aware of any study to date designed to investigate why TB/HIV co-infected patients have a greater mortality during intensive phase of TB treatment in sub-Saharan Africa. We examine the incidence and socio-demographic, clinical, and laboratory factors associated with death during intensive phase of TB treatment in our cohort of TB/HIV co-infected patients. Understanding contributors to mortality during the initial phase of tuberculosis (TB) treatment in patients co-infected with HIV would guide targeted interventions to improve survival. The aim of this study was to ascertain the incidence of death during the initial 2 months (new cases) and 3 months (retreatment cases) of TB treatment and to assess correlates of mortality in HIV co-infected patients

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