Background: Few data is available in low-burden TB-HIV countries on TB treatment outcomes. We evaluated TB patients (pts) characteristics by HIV status and compared treatment outcomes in relation to HIV status, CD4 count and antiretroviral therapy (ART). Methods: We performed a retrospective analysis of 447 adult TB pts who registered and initiated treatment in our center from 2014 to 2015. Results: Pts were categorized as HIV-negative (n = 399, 89.3%), HIV-positive on ART (n = 42, 9.4%) and HIV-positive not on ART (n = 6, 1.3%). The proportion of pts with extended TB therapy was higher among HIV-positive pts (p = 0.03). Increased age was associated with higher death rates regarding treatment success (OR 1.08; 95% CI 1.01 - 1.17, p = 0.03). Statistically significant higher mortality was found among HIV-positive pts on ART (OR 9.93; 95% CI 1.36 - 72.37, p = 0.03) and HIV-positive pts not on ART (OR 397.00; 95% CI 44.27 to 3559.91, p ≤ 0.0001) compared to HIV-negative pts. When multivariate analyses were restricted to HIV-positive pts, being not on ART was associated with higher mortality (OR 40.0; 95% CI 4.37 - 365.78, p = 0.001). Conclusions: There was significant difference in death rates between HIV-positive and HIV-negative TB pts. HIV-positive pts not on ART had a significantly higher mortality.
References
[1]
(2017) Global Tuberculosis Report. World Health Organization, Geneva.
[2]
Sharma, S.K., Mohan, A. and Kadhiravan, T. (2005) HIV-TB Co-Infection: Epidemiology, Diagnosis and Management. Indian Journal of Medical Research, 121, 550-567.
[3]
Diniz, A., Duarte, R., Bettencourt, J., Melo, T., Gomes, M. and Oliveira, O. (2015) Portugal, Infeçãopor VIH, SIDA e Tuberculoseemnúmeros, Pinto Azul, Unipessoal Lda, Lisboa.
[4]
Pimpin, L., Drumright, L.N., Kruijshaar, M.E., Abubakar, I., Rice, B., Delpech, V., et al. (2011) Tuberculosis and HIV Co-Infection in European Union and European Economic Area Countries. European Respiratory Journal, 38, 1382-1392.
https://doi.org/10.1183/09031936.00198410
[5]
Kwan, C.K. and Ernst, J.D. (2011) HIV and Tuberculosis: A Deadly Human Syndemic. Clinical Microbiology Reviews, 24, 351-376.
https://doi.org/10.1128/CMR.00042-10
[6]
Harries, A., Maher, D. and Graham, S. (2004) TB/HIV: A Clinical Manual. 2th Edition, World Health Organization.
[7]
Banerjee, A., Moyo, S., Salaniponi, F. and Harries, A. (1997) HIV Testing and Tuberculosis Treatment Outcome in a Rural District in Malawi. Transactions of the Royal Society of Tropical Medicine and Hygiene, 91, 707-708.
https://doi.org/10.1016/S0035-9203(97)90533-2
[8]
Sume, G.E., Hoshen, M., Bita, G., Kabore, S. and Nzima, V.N. (2009) Treatment Outcome of TB/HIV Positive and Negative Smear Positive Pulmonary Tuberculosis Patients Treated Using Daily Self-Administered Therapy in a Cameroonian District Hospital. East African Medical Journal, 86, 469-475.
[9]
Daniel, O.J. and Alausa, O.K. (2006) Treatment Outcome of TB/HIV Positive and TB/HIV Negative Patients on Directly Observed Treatment, Short Course (DOTS) in Sagamu, Nigeria. Nigerian Journal of Medicine, 15, 222-226.
[10]
Shaweno, D. and Worku, A. (2012) Tuberculosis Treatment Survival of HIV Positive TB Patients on Directly Observed Treatment Short-Course in Southern Ethiopia: A Retrospective Cohort Study. BMC Research Notes, 5, 682.
https://doi.org/10.1186/1756-0500-5-682
[11]
Tweya, H., Feldacker, C., Phiri, S., Ben-Smith, A., Fenner, L., Jahn, A., et al. (2013) Comparison of Treatment Outcomes of New Smear-Positive Pulmonary Tuberculosis Patients by HIV and Antiretroviral Status in a TB/HIV Clinic, Malawi. PLoS One, 8, e56248. https://doi.org/10.1371/journal.pone.0056248
[12]
Njepoume, N., Odume, B. and Suraj, A. (2009) The Impact of HIV Syndroms on the Treatment Outcome of TB Cases: Results from a State TB Programme in Nigeria. International Journal of Tuberculosis and Lung Disease, 13, 316.
[13]
van den Broek, J., Mfinanga, S., Moshiro, C., O’Brien, R., Mugomela, A. and Lefi, M. (1998) Impact of Human Immunodeficiency Virus Infection on the Outcome of Treatment and Survival of Tuberculosis Patients in Mwanza, Tanzania. International Journal of Tuberculosis and Lung Disease, 2, 547-552.
[14]
El-Sony, A.I., Khamis, A.H., Enarson, D.A., Baraka, O., Mustafa, S.A. and Bjune, G. (2002) Treatment Results of DOTS in 1797 Sudanese Tuberculosis Patients with or without HIV Co-Infection. International Journal of Tuberculosis and Lung Disease, 6, 1058-66.
[15]
Fujiwara, P.I., Dlodlo, R.A., Ferroussier, O., Nakanwagi-Mukwaya A., Cesari, G. and Boillot, E. (2012) Implementing Collaborative TB-HIV Activities: A Programmatic Guide. Paris, France. International Union against Tuberculosis and Lung Disease.
[16]
Yew, W.W., Lange, C. and Leung, C.C. (2011) Treatment of Tuberculosis: Update 2010. European Respiratory Journal, 37, 441-462.
https://doi.org/10.1183/09031936.00033010
[17]
Panel on Antiretroviral Guidelines for Adults and Adolescents (2011) Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Department of Health and Human Services, 14 October 2011, 1-167.
[18]
Guerreiro, C., Aldir, I., Oliveira, J., Mansinho, K., Marques, L., Doroana, M., et al. (2016) Recomendações Portuguesas para o tratamento da infeção por VIH-1 e VIH-2, Versão 1.0.
[19]
Mweete, D., Nglazi1, Bekker L., Wood, R. and Kaplan R. (2015) The Impact of HIV Status and Antiretroviral Treatment on TB Treatment Outcomes of New Tuberculosis Patients Attending Collocated TB and ART Services in South Africa: A Retrospective Cohort Study. BMC Infectious Diseases, 15, 536.
https://doi.org/10.1186/s12879-015-1275-3
[20]
Lawn, S.D., Myer, L., Edwards, D., Bekker, L.G. and Wood, R. (2009) Short-Term and Long-Term Risk of Tuberculosis Associated with CD4 Cell Recovery during Antiretroviral Therapy in South Africa. AIDS, 23, 1717-1725.
https://doi.org/10.1097/QAD.0b013e32832d3b6d
[21]
Karim, S.S., Naidoo, K., Grobler, A., Padayatchi, N., Baxter, C., Gray, A.L., et al. (2011) Integration of Antiretroviral Therapy with Tuberculosis Treatment. The New England Journal of Medicine, 365, 1492-1501.
https://doi.org/10.1056/NEJMoa1014181
[22]
Blanc, F.X., Sok, T., Laureillard, D., Borand, L., Rekacewicz, C., Nerrienet, E., et al. (2011) Earlier versus Later Start of Antiretroviral Therapy in HIV-Infected Adults with Tuberculosis. The New England Journal of Medicine, 365, 1471-1481.
https://doi.org/10.1056/NEJMoa1013911
[23]
Havlir, D.V., Kendall, M.A., Ive, P., Kumwenda, J., Swindells, S., Qasba, S.S., et al. (2011) Timing of Antiretroviral Therapy for HIV-1 Infection and Tuberculosis. The New England Journal of Medicine, 365, 1482-1491.
https://doi.org/10.1056/NEJMoa1013607
[24]
Gebremariam, G., Asmamaw, G., Hussen, M., Hailemariam, M.Z., Asegu, D., Astatkie, A., et al. (2016) Impact of HIV Status on Treatment Outcome of Tuberculosis Patients Registered at Arsi Negele Health Center, Southern Ethiopia: A Six Year Retrospective Study. PLoS ONE, 11, e0153239.
https://doi.org/10.1371/journal.pone.0153239
[25]
Sanchez, M., Bartholomay, P., Arakaki-Sanchez, D., Enarson, D., Bissell, K., et al. (2012) Outcomes of TB Treatment by HIV Status in National Recording Systems in Brazil, 2003-2008. PLoS ONE, 7, e33129.
https://doi.org/10.1371/journal.pone.0033129