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Survival of HIV-TB co-infected adult patients under ART in Ambo Referral Hospital, Ethiopia
Abstract
Background: HIV infection is the greatest risk factor for acquiring TB infection and developing the disease. TB enhances HIV replication by accelerating the natural evolution of HIV infection; it is the leading cause of sickness and death of people living with HIV.
Objectives: To estimate the survival of HIV/AIDS co-infected patients and to identify predictors of survival based on data obtained from Ambo referral hospital, West Shoa Zone in Oromia Regional State, Ethiopia.
Methods: This retrospective study was conducted based on data collected in 501 cases of HIV-infected TB patients of age 15 years and above who started anti-TB treatment between September 1, 2006 and August 31, 2011 and followed until February 29, 2012. The Kaplan-Meier method and the log-rank test were used to compare the survival experience of different categories of patients. The Cox regression model was employed to identify predictors of mortality.
Results: A total of 79 deaths occurred during the follow up period of 78.66 months. Of these 49 patients died within the first nine months after initiation of the anti-TB treatment and the remaining 30 died after finishing the treatment; the last death occurred at 67.83 months. The overall median survival of the 79 death cases was 27.7 months. The Cox regression analysis showed that initial weight, TB site (pulmonary or extra-pulmonary), WHO clinical stage, functional status and CD4 count were significant risk factors. The most important predictors associated with higher risk of death at 0.05 level of significance were: low initial weight, low CD4 count, WHO stages III and IV as well as ambulatory and bedridden physical conditions.
Conclusion: A careful monitoring of the health status of patients with low initial weight, low CD4 cell count, advanced WHO stages III & IV, ambulatory and bedridden functional status is necessary to improve the survival of HIV-TB co-infected patients at initiation of and during anti-TB treatment
Objectives: To estimate the survival of HIV/AIDS co-infected patients and to identify predictors of survival based on data obtained from Ambo referral hospital, West Shoa Zone in Oromia Regional State, Ethiopia.
Methods: This retrospective study was conducted based on data collected in 501 cases of HIV-infected TB patients of age 15 years and above who started anti-TB treatment between September 1, 2006 and August 31, 2011 and followed until February 29, 2012. The Kaplan-Meier method and the log-rank test were used to compare the survival experience of different categories of patients. The Cox regression model was employed to identify predictors of mortality.
Results: A total of 79 deaths occurred during the follow up period of 78.66 months. Of these 49 patients died within the first nine months after initiation of the anti-TB treatment and the remaining 30 died after finishing the treatment; the last death occurred at 67.83 months. The overall median survival of the 79 death cases was 27.7 months. The Cox regression analysis showed that initial weight, TB site (pulmonary or extra-pulmonary), WHO clinical stage, functional status and CD4 count were significant risk factors. The most important predictors associated with higher risk of death at 0.05 level of significance were: low initial weight, low CD4 count, WHO stages III and IV as well as ambulatory and bedridden physical conditions.
Conclusion: A careful monitoring of the health status of patients with low initial weight, low CD4 cell count, advanced WHO stages III & IV, ambulatory and bedridden functional status is necessary to improve the survival of HIV-TB co-infected patients at initiation of and during anti-TB treatment
