Survival Experience and its Predictors among TB/HIV Co-infected Patients in Southwest Ethiopia

Abstract

Background: HIV-TB co-infection is “bidirectional and synergistic”. HIV promotes the progression of latent tuberculosis infection to disease and tuberculosis accelerates the progression of HIV disease to its advanced stage. To date, there have been limited clinical data regarding survival rates among TB/HIV co-infected patients and the impact of antiretroviral therapy on clinical outcomes in developing countries. Therefore, this study assessed the predictors of TB/HIV associated mortality in a cohort of HIV infected patients treated with antiretroviral therapy in Jimma University Teaching Hospital. Methods: Retrospective study was conducted in Jimma University Teaching Hospital from September 01, 2010 to August 31, 2012. All records of adult TB-HIV co-infected patients who follow TB-HIV care in Jimma University Teaching Hospital between 01 September of 2010 and 31 August of 2012 were retrieved. Data were entered by Epidata and was exported to SPSS version 19. Data were analyzed using proportional hazards cox model with stepwise variable selection to identify independent predictors. P value below 0.05 was considered statistically significant in the final model. Results: Fifty five (20.2%) Tb HIV co-infected patients were died in the year September 2010 to August 2012, and 272 study subjects contributed 3, 082.7 person month observations. Age between 35-44 years (AHR=2.9; 95%CI: 1.08-7.6), being commercial sex worker (AHR=9.1; 95%CI: 2.7-30.7), bed ridden functional status (AHR=3.2; 95%CI: 1.2-8.7), and WHO stages 2 (AHR=0.2; 95%CI: 0.06-0.5), 3(AHR=0.3; 95%CI: 0.1-0.8) and 4(AHR=0.2; 95%CI: 0.04-0.55) were the independent factors affecting mortality of TB-HIV co-infected patients. Conclusions: More than 1 in 5 TB-HIV co-infected individuals died. The independent predictors were age between 35-44 years, being student and commercial sex worker, bed ridden functional status, and WHO stages 2, 3, and 4. Therefore, attention should be given to reduce the considerable amount of death, and specific intervention should be designed focusing on the independent predictors