Risk factors for mortality in patients with tuberculosis and HIV in Douala (Cameroon)

Abstract

Despite prevention efforts, and free treatment, TB-HIV co-infection still occurs in Cameroon. The objective of this work is to present the risk factors for mortality in patients co-infected with TB and HIV in Douala from 2009 to 2014. This transversal, analytic, and retrospective study took place from November 2014 to May 2015 in the Laquintinie Hospital in Douala. A review of our records identified patients aged at least 15years, with this co-infection who received TB treatment, with or without antiretroviral agents. The bivariate analysis compared qualitative variables with Pearson's Chi2 test. In the multivariate analysis, we determined the risk factors for mortality by backward stepwise logistic regression. Model fit was tested with the Hosmer-Lemeshow test. The study identified 394 patients, 213 (54.1%) of whom were women (sex ratio 0.84). The mean age was 39 ± 10 years. All patients received drugs to treat tuberculosis drugs; 351 (89%) also received antiretroviral drugs, 78.2% of them including efavirenz; and 320 (81.2%) received cotrimoxazole prophylaxis. During the study period, 67.3% were cured of tuberculosis and 15.7% died. The multivariate regression results show that hepatitis B (P <0.0009), absence of cotrimoxazole prophylaxis (P <0.005), poor treatment adherence (P <0.0001), and a CD4 count <50 (P <0.0001) were risk factors for mortality. The cure rate for patients co-infected with TB and HIV in Cameroon remains low, and their mortality high. Comorbidities and the presence of opportunistic diseases are risk factors for death. Appropriate measures to prevent this co-infection and the systematic use of cotrimoxazole should reduce this mortality rate.