Treatment outcomes of daily anti-tuberculosis treatment in HIV-infected patients seeking care at a private clinic in India.

Abstract

Little is known about outcomes of patients co-infected with human immunodeficiency virus (HIV) and tuberculosis (TB) who are treated in the private sector in India. To describe the treatment outcomes of daily anti-tuberculosis treatment (ATT) and their determinants among HIV-TB co-infected patients treated at a private clinic in Pune, India. Data on adult HIV-TB co-infected patients treated with daily ATT were analysed using logistic regression and Cox model to assess risk factors for default and death. Of 769 cases, 78% were aged <45 years, 71% were males, 64% had CD4 < 200 cells/mm3, 67% were antiretroviral treatment (ART) naïve at TB diagnosis, 53% had extra-pulmonary TB, and 12% had a past history of TB. ATT was successfully completed by 58.5%, 34.3% defaulted (i.e., discontinued ATT for >2 months) and 3.9% died during ATT. The risk of default was higher among males (aOR 1.67, 95%CI 1.17-2.39), ART-naïve patients (aOR 1.91, 95%CI 1.34-2.73) and those with a past history of TB (aOR 1.86, 95%CI 1.15-3.01). Survival probability at 365 days was 95% (95%CI 93-97). The risk of death was higher among patients with CD4 < 50 cells/mm3 (aHR 4.63, 95%CI 1.47-14.65) than in those with CD4 > 200 cells/mm3. Low overall mortality was seen with daily ATT in HIV-TB co-infected patients. High default rates in private facilities warrant urgent attention.