Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

Juan Ignacio García,Manuel Fernández-Quevedo,Alberto L Garcia-Basteiro,Tacilta Nhampossa,Charfudin Sacoor,Maxime Leroux-La Pierre,Elisa López-Varela,Helio Chiconela,Durval Respeito,Edson Mambuque,Dinis Nguenha,Victor Guillermo Sequera,Belén Saavedra,Luis A Faife,Faustino Vilanculo

doi:10.1038/s41598-020-71784-3

Abstract

Tuberculosis (TB) misdiagnosis remains a public health concern, especially among people living with HIV (PLHIV), given the high mortality associated with missed TB diagnoses. The main objective of this study was to describe the all-cause mortality, TB incidence rates and their associated risk factors in a cohort of PLHIV with presumptive TB in whom TB was initially ruled out. We retrospectively followed a cohort of PLHIV with presumptive TB over a 2 year-period in a rural district in Southern Mozambique. During the study period 382 PLHIV were followed-up. Mortality rate was 6.8/100 person-years (PYs) (95% CI 5.2–9.2) and TB incidence rate was 5.4/100 PYs (95% CI 3.9–7.5). Thirty-six percent of deaths and 43% of TB incident cases occurred in the first 12 months of the follow up. Mortality and TB incidence rates in the 2-year period after TB was initially ruled out was very high. The TB diagnostic work-up and linkage to HIV care should be strengthened to decrease TB burden and all-cause mortality among PLHIV with presumptive TB.

Highlights

Tuberculosis (TB) remains an important public health concern and constitutes the leading cause of death from a single infectious disease a gent[1]
This study aims to describe the all-cause mortality and TB incidence rates among people living with HIV (PLHIV) with presumptive TB in which TB was initially ruled out, and to describe sociodemographic risk factors associated with death and incident TB
There were 133 (34.8%) PLHIV lost to HIV care (PLHIV with presumptive TB who did not attend the last HIV care visit scheduled and remained without a follow-up visit within a period of 6 months or more since the last visit attended until the end of the follow-up period)

Summary

Introduction

Tuberculosis (TB) remains an important public health concern and constitutes the leading cause of death from a single infectious disease a gent[1]. Avoiding TB misdiagnosis is critical to correctly rule in or out TB among TB presumptive individuals. This has special relevance among people living with HIV (PLHIV), who have an increased risk of TB and mortality due to TB6,7. Several studies have shown the increased mortality associated with TB misdiagnosis, in particular, with TB underdiagnosis[8,9]. PLHIV with clinically diagnosed TB have a higher mortality risk than those with laboratory-confirmed TB17 highlighting the importance of improving laboratory-based TB diagnosis in this population. This study aims to describe the all-cause mortality and TB incidence rates among PLHIV with presumptive TB in which TB was initially ruled out, and to describe sociodemographic risk factors associated with death and incident TB

Objectives

Methods

Results

Conclusion