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Incidence of tuberculosis and early mortality in a large cohort of HIV infected patients receiving antiretroviral therapy in a tertiary hospital in Addis Ababa, Ethiopia

Kassa, Aragie ; Teka, Azmera ; Shewaamare, Aster and Jerene, Degu LU (2012) In Transactions of the Royal Society of Tropical Medicine and Hygiene 106(6). p.70-363
Abstract

Preceding studies on morbidities and mortalities associated with TB in a cohort of HIV care indicate high incidence of TB development and premature death among patients on highly active antiretroviral treatment (HAART). This study aims to measure the rate of TB, TB mortality, and associated risk factors following commencement of HAART in a cohort of patients attending HIV care in Ethiopia. Patient information was gathered from the hospital register and analysed. TB incidence peaked within six months of HAART initiation, and dropped from 3.3/100 person-years in the first year to 0.4/100 person-years in the fifth year. At baseline, risk factors associated with TB included WHO clinical stage 3 HIV infection (adjusted hazard ratio (AHR)... (More)

Preceding studies on morbidities and mortalities associated with TB in a cohort of HIV care indicate high incidence of TB development and premature death among patients on highly active antiretroviral treatment (HAART). This study aims to measure the rate of TB, TB mortality, and associated risk factors following commencement of HAART in a cohort of patients attending HIV care in Ethiopia. Patient information was gathered from the hospital register and analysed. TB incidence peaked within six months of HAART initiation, and dropped from 3.3/100 person-years in the first year to 0.4/100 person-years in the fifth year. At baseline, risk factors associated with TB included WHO clinical stage 3 HIV infection (adjusted hazard ratio (AHR) 2.53; 95% CI 1.70-3.70), WHO clinical stage 4 HIV infection (AHR, 3.86; 95% CI 2.54-5.86), and patients who were bed ridden >50% a day (AHR, 1.52; 95% CI 1.13-2.05). The rate of mortality was 6.9% (incidence 2.8 per 100 person-years) and 57% of deaths occurred in the first six months of HAART initiation. Multivariate Cox model indicated WHO clinical stage 4 HIV infection, CD4+ cell count <50 cells/μl, bed ridden >50% a day, and TB after HAART initiation as baseline independent predictors of mortality. Additional evidence shows that regular CD4+monitoring of patients before HAART initiation as well as earlier HAART initiation decreases death, and regular clinical staging decreases TB incidence.

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author
; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
AIDS-Related Opportunistic Infections/epidemiology, Adult, Anti-HIV Agents/administration & dosage, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Cohort Studies, Early Diagnosis, Ethiopia/epidemiology, Female, HIV Seropositivity/drug therapy, Hospital Mortality/trends, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Risk Factors, Tuberculosis/epidemiology
in
Transactions of the Royal Society of Tropical Medicine and Hygiene
volume
106
issue
6
pages
8 pages
publisher
Oxford University Press
external identifiers
  • scopus:84861340576
  • pmid:22521216
ISSN
1878-3503
DOI
10.1016/j.trstmh.2012.03.002
language
English
LU publication?
no
id
a14d12db-a98a-4080-8051-fa643eeb61d9
date added to LUP
2021-09-08 17:52:24
date last changed
2024-01-05 15:45:50
@article{a14d12db-a98a-4080-8051-fa643eeb61d9,
  abstract     = {{<p>Preceding studies on morbidities and mortalities associated with TB in a cohort of HIV care indicate high incidence of TB development and premature death among patients on highly active antiretroviral treatment (HAART). This study aims to measure the rate of TB, TB mortality, and associated risk factors following commencement of HAART in a cohort of patients attending HIV care in Ethiopia. Patient information was gathered from the hospital register and analysed. TB incidence peaked within six months of HAART initiation, and dropped from 3.3/100 person-years in the first year to 0.4/100 person-years in the fifth year. At baseline, risk factors associated with TB included WHO clinical stage 3 HIV infection (adjusted hazard ratio (AHR) 2.53; 95% CI 1.70-3.70), WHO clinical stage 4 HIV infection (AHR, 3.86; 95% CI 2.54-5.86), and patients who were bed ridden &gt;50% a day (AHR, 1.52; 95% CI 1.13-2.05). The rate of mortality was 6.9% (incidence 2.8 per 100 person-years) and 57% of deaths occurred in the first six months of HAART initiation. Multivariate Cox model indicated WHO clinical stage 4 HIV infection, CD4+ cell count &lt;50 cells/μl, bed ridden &gt;50% a day, and TB after HAART initiation as baseline independent predictors of mortality. Additional evidence shows that regular CD4+monitoring of patients before HAART initiation as well as earlier HAART initiation decreases death, and regular clinical staging decreases TB incidence.</p>}},
  author       = {{Kassa, Aragie and Teka, Azmera and Shewaamare, Aster and Jerene, Degu}},
  issn         = {{1878-3503}},
  keywords     = {{AIDS-Related Opportunistic Infections/epidemiology; Adult; Anti-HIV Agents/administration & dosage; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Cohort Studies; Early Diagnosis; Ethiopia/epidemiology; Female; HIV Seropositivity/drug therapy; Hospital Mortality/trends; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Risk Factors; Tuberculosis/epidemiology}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{70--363}},
  publisher    = {{Oxford University Press}},
  series       = {{Transactions of the Royal Society of Tropical Medicine and Hygiene}},
  title        = {{Incidence of tuberculosis and early mortality in a large cohort of HIV infected patients receiving antiretroviral therapy in a tertiary hospital in Addis Ababa, Ethiopia}},
  url          = {{http://dx.doi.org/10.1016/j.trstmh.2012.03.002}},
  doi          = {{10.1016/j.trstmh.2012.03.002}},
  volume       = {{106}},
  year         = {{2012}},
}