Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study.

Gustavo E Velásquez,Hector O Jave,J Peter Cegielski,Christian Rojas,Janeth Santa Cruz,Gloria Yale,Carmen Contreras ,Martín Yagui ,Jaime Bayona ,Eduardo Sánchez ,Sidney Atwood ,César Bonilla ,Megan Murray ,Luis Asencios ,Carmen Suárez ,Sonya Shin

doi:10.1186/s12879-016-1375-8

Abstract

BackgroundHuman immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting.MethodsWe conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment.ResultsOf 1701 participants treated for tuberculosis, 136 (8.0 %) died during tuberculosis treatment. HIV-positive patients constituted 11.0 % of the cohort and contributed to 34.6 % of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9 %, P < 0.001) and less likely to be cured (28.3 vs. 39.4 %, P = 0.003). On multivariate analysis, positive HIV status (hazard ratio [HR] = 6.06; 95 % confidence interval [CI], 3.96–9.27), unemployment (HR = 2.24; 95 % CI, 1.55–3.25), and sputum acid-fast bacilli smear positivity (HR = 1.91; 95 % CI, 1.10–3.31) were significantly associated with a higher hazard of death.ConclusionsWe demonstrate that positive HIV status was a strong predictor of mortality among patients treated for tuberculosis in the early years after Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality.

Highlights

Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade
We enrolled all patients with confirmed TB or presumptive TB with respiratory symptoms for at least 2 weeks who were living in 2 adjacent health regions in Lima (Lima Ciudad and Lima Este), and who met Peruvian National Tuberculosis Control Program (NTP) criteria for drug-susceptibility testing (DST) referral (Table 1) [13]
HIV-positive patients tended to experience a shorter mean duration of TB symptoms before DST referral (2.5 ± 3.0 vs. 3.5 ± 4.9 months), but presented with more severe clinical findings such as weight loss, low body mass index (BMI), dyspnea, and poor functional status in terms of ability to perform activities of daily living (ADLs). They were more likely to present with extrapulmonary TB and fewer pulmonary findings (abnormal chest x-rays (CXR), cavitary disease, hemoptysis, sputum acid-fast bacilli (AFB) smear positivity)

Summary

Introduction

Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. The global number of human immunodeficiency virus (HIV)-associated tuberculosis (TB) deaths has been decreasing since 2004 [1]. Only 1.9 % of all Peruvian TB patients had a known HIV status in 2005, and 1.2 % of known HIV-positive TB patients were on ART in 2010 [11]. During this period, Peru implemented aggressive tuberculosis control strategies, including rapid diagnosis and individualized regimens for MDR-TB [12, 13]. While there have been significant gains in diagnosis of HIV and ART provision for TB/HIV co-infected patients worldwide, in high HIV prevalence settings, we sought to quantify

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