Factors Associated with Mortality of TB/HIV Co-infected Patients in Ethiopia

Abstract

Background: Despite the large number of TBpatients on ART in Ethiopia, their mortalityremains high. This study reports the effect of TBon HIV related mortality and determinants ofTB/HIV co-infection related mortality.Methods: A longitudinal study design wasemployed as part of the Advanced ClinicalMonitoring of ART (ACM) in Ethiopia. Allpatients started on ART at or after January 1,2005 were included. Survival analysis was doneto compare survival patterns of HIV patients withTB against HIV patients without TB. In addition,determinants of survival among TB/HIV co-infected patients were analyzed. Adjusted effectsof the different factors on time to death weregenerated using Cox-proportional hazardsregression.Results: A total of 3,889 patients were enrolled inthe ACM study, of which 355 TB cases wereidentified, making the crude prevalence 9% (95%CI 8.3 – 10.2). Overall, incidence of TB was 2.2(95% CI 1.9-2.4) per 100 person-years. TB washighest in the first 2 months and declined withtime on ART to reach 1 per 100 person yearsafter 24 months on ART. TB was significantlyassociated with mortality among HIV patients onHAART (AHR 2.0, 95% CI 1.47-2.75). Malegender was associated with mortality amongTB/HIV co-infected patients.Conclusion: Tuberculosis plays a key role inHIV associated mortality. Targeted interventionswhich can keep patients free of TB in the earlystages of their treatment are required to reduceTB related mortality.