Treatment outcome and mortality at one and half year follow-up of HIV infected TB patients under TB control programme in a district of South India.

Sophia Vijay,Preetish Vaidyanathan,Lakbir Singh Chauhan,Saroja Vadigepalli Narayan Rao,Prahlad Kumar,Madhukar Pai

doi:10.1371/journal.pone.0021008

Sophia Vijay, Preetish Vaidyanathan + Show 4 more

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https://doi.org/10.1371/journal.pone.0021008

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Abstract

BackgroundThere is paucity of data from India on the impact of HIV related immunosuppression in response to TB treatment and mortality among HIV infected TB patients. We assessed the TB treatment outcome and mortality in a cohort of HIV infected TB patients treated with intermittent short course chemotherapy under TB control programme in a high HIV prevalent district of south India.Methodology/ FindingsAmong 3798 TB patients registered for treatment in Mysore district from July 2007 to June 2008, 281 HIV infected patients formed the study group. The socio-demographic and treatment related data of these patients was obtained from TB and HIV programme records and patient interviews 19 months after TB treatment initiation by field investigators. Treatment success rate of 281 patients was 75% while in smear positive pulmonary tuberculosis cases it was 62%, attributable to defaults (16%) and deaths (19%). Only 2 patients had treatment failure. Overall, 83 (30%) patients were reported dead; 26 while on treatment and 57 after TB treatment. Association of treatment related factors with treatment outcome and survival status was studied through logistic regression analysis. Factors significantly associated with ‘unfavourable outcome’ were disease classification as Pulmonary [aOR-1.96, CI (1.02–3.77)], type of patient as retreatment [aOR-4.78, CI (2.12–10.76)], and non initiation of ART [aOR-4.90, CI (1.85–12.96)]. Factors associated with ‘Death’ were non initiation of ART [aOR-2.80, CI (1.15–6.81)] and CPT [aOR-3.46, CI (1.47–8.14)].ConclusionDespite the treatment success of 75% the high mortality (30%) in the study group is a matter of concern and needs immediate intervention. Non initiation of ART has emerged as a high risk factor for unfavourable treatment outcome and mortality. These findings underscore the importance of expanding and improving delivery of ART services as a priority and reconsideration of the programme guidelines for ART initiation in HIV infected TB patients.

Highlights

TB is the commonest Opportunistic Infection (OI) among HIV infected patients, in the developing countries [1,2]
Despite the treatment success of 75% the high mortality (30%) in the study group is a matter of concern and needs immediate intervention
Non initiation of Anti Retroviral Treatment (ART) has emerged as a high risk factor for unfavourable treatment outcome and mortality

Summary

Introduction

TB is the commonest Opportunistic Infection (OI) among HIV infected patients, in the developing countries [1,2]. The HIV/AIDS epidemic has a dramatic impact on the epidemiology of tuberculosis. This has increased the global tuberculosis burden [4] especially in populations where HIV is common and where the prevalence of tuberculosis infection is high [5,6]. There is paucity of data from India on the impact of HIV related immunosuppression in response to TB treatment and mortality among HIV infected TB patients.

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