Abstract
Impact of HIV status, CD4 count and antiretroviral treatment on tuberculosis treatment outcomes in a low-burden country
Background: Although studies with mixed results from high-burden tuberculosis (TB) countries have examined the impact of HIV infection on TB treatment outcomes, few data is available in low burden TB-HIV countries.
Aims: To evaluate TB patients (pts) characteristics by HIV status and compare TB treatment outcomes in relation to HIV status, CD4 count and antiretroviral therapy (ART).
Methods: We performed a retrospective analysis of 447 new adult TB pts who registered and initiated TB treatment in our center from 2014 to 2015. TB treatment outcomes were analyzed using multinomial logistic regression, with treatment success as the reference outcome.
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 who had 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 40.00; 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. These findings strain the need for an intervention aimed at preventing TB-HIV co-infection and improving ART uptake.