Advanced

Factors associated with adverse treatment outcomes of Tuberculosis among HIV-positive adults in an antiretroviral treatment program in Yangon, Myanmar

Lin, Tharaphi LU (2016) MPHN40 20161
Social Medicine and Global Health
Abstract
Introduction: Tuberculosis (TB) is the most common opportunistic infection (OI) and cause of death in people living with HIV/AIDS (PLHIV), even in settings with access to antiretroviral therapy (ART). This study aims to determine factors associated with adverse outcome of TB
treatment in PLHIV.
Materials and Method: The study was retrospective cohort study which includes 958 individuals aged ≥15 years who were registered in a large ART program with comprehensive care for HIV in Yangon. The study period was between January 2012 to December 2014. All individuals who were diagnosed with both HIV and TB were included in the study. Patients’ characteristics, TB history, ART status, CD4 cell count and sputum smear microscopy result were... (More)
Introduction: Tuberculosis (TB) is the most common opportunistic infection (OI) and cause of death in people living with HIV/AIDS (PLHIV), even in settings with access to antiretroviral therapy (ART). This study aims to determine factors associated with adverse outcome of TB
treatment in PLHIV.
Materials and Method: The study was retrospective cohort study which includes 958 individuals aged ≥15 years who were registered in a large ART program with comprehensive care for HIV in Yangon. The study period was between January 2012 to December 2014. All individuals who were diagnosed with both HIV and TB were included in the study. Patients’ characteristics, TB history, ART status, CD4 cell count and sputum smear microscopy result were extracted from the clinic database and patient’s medical journals to determine the association with TB treatment outcomes. Data analysis was done by univariate and multivariate logistic regression.
Result: Median age of patients was 34 years and 61.5% were male patients. Of 958 patients,654(68.3%) of participants had favorable treatment outcomes, whereas 186(19.4%) died, 88(9.2%) loss to follow up and 30(3.1%) treatment failure during 12 months of study period. The ART coverage was 80% in all TB-HIV co-infected patients. The adverse outcomes were mostly seen in the group of patients who did not receive ART and who did not get tested for CD4 cell counts. Patients who did not receive antiretroviral therapy during the course of antituberculosis treatment and low CD4 cell count at the diagnosis of TB were statistically significant predictors (P value .000) for adverse treatment outcomes of TB. No difference in adverse outcome was seen in patients who had ART in 8 weeks of ATT and after 8 weeks of ATT.
Conclusion: Early diagnosis of both infections and early ART initiation during the course of ATT are important factors in preventing adverse outcome of Tuberculosis. (Less)
Popular Abstract
Human Immunodeficiency virus (HIV) and Tuberculosis (TB) are most common co-infected infections in people living with HIV and TB is the most common cause of death in HIV patients. Therefore, it is important to know the risk factors associated with adverse treatment outcomes of Tuberculosis to improve quality of life in people who are infected with both TB and HIV.
A study conducted in Myanmar among 958 HIV patients aged 15 years and above found that adverse TB treatment outcomes were seen in patients who were not receiving ART during the course of TB treatment and severely weakened immune system. The data was collected from the database and from the medical journals of the patients who were treated in an ART program of a non-government... (More)
Human Immunodeficiency virus (HIV) and Tuberculosis (TB) are most common co-infected infections in people living with HIV and TB is the most common cause of death in HIV patients. Therefore, it is important to know the risk factors associated with adverse treatment outcomes of Tuberculosis to improve quality of life in people who are infected with both TB and HIV.
A study conducted in Myanmar among 958 HIV patients aged 15 years and above found that adverse TB treatment outcomes were seen in patients who were not receiving ART during the course of TB treatment and severely weakened immune system. The data was collected from the database and from the medical journals of the patients who were treated in an ART program of a non-government organization called Medical Action Myanmar (MAM) during January 2012 to December 2014.
Majority of participants were middle aged men aged between 30-44 years. Although all patients with both TB and HIV infections should receive early treatment for both HIV and TB, only 80% of patients were provided with HIV treatment so called antiretroviral therapy (ART) in this program. About 30% of patients had adverse outcomes, either died or loss to follow up from the program or treatment failure of TB. Adverse outcomes were mostly seen in a group of patients who did not get their immunity tested and who never received ART. This is because they come to clinic in their late stage of HIV, developed several complications and most of them died shortly after the diagnosis.
The study showed that comprehensive HIV care program, with early HIV diagnosis, providing early ART to all HIV-TB infected patients, early diagnosis of TB and effective treatment of TB, is needed in Myanmar to reduce adverse treatment outcomes of Tuberculosis in HIV patients. (Less)
Please use this url to cite or link to this publication:
author
Lin, Tharaphi LU
supervisor
organization
course
MPHN40 20161
year
type
H2 - Master's Degree (Two Years)
subject
keywords
HIV, AIDS, TB, ART, ATT, CD4 cell count, adverse treatment outcomes
language
English
id
8896194
date added to LUP
2017-01-16 14:42:03
date last changed
2017-04-19 04:09:23
@misc{8896194,
  abstract     = {Introduction: Tuberculosis (TB) is the most common opportunistic infection (OI) and cause of death in people living with HIV/AIDS (PLHIV), even in settings with access to antiretroviral therapy (ART). This study aims to determine factors associated with adverse outcome of TB
treatment in PLHIV.
Materials and Method: The study was retrospective cohort study which includes 958 individuals aged ≥15 years who were registered in a large ART program with comprehensive care for HIV in Yangon. The study period was between January 2012 to December 2014. All individuals who were diagnosed with both HIV and TB were included in the study. Patients’ characteristics, TB history, ART status, CD4 cell count and sputum smear microscopy result were extracted from the clinic database and patient’s medical journals to determine the association with TB treatment outcomes. Data analysis was done by univariate and multivariate logistic regression.
Result: Median age of patients was 34 years and 61.5% were male patients. Of 958 patients,654(68.3%) of participants had favorable treatment outcomes, whereas 186(19.4%) died, 88(9.2%) loss to follow up and 30(3.1%) treatment failure during 12 months of study period. The ART coverage was 80% in all TB-HIV co-infected patients. The adverse outcomes were mostly seen in the group of patients who did not receive ART and who did not get tested for CD4 cell counts. Patients who did not receive antiretroviral therapy during the course of antituberculosis treatment and low CD4 cell count at the diagnosis of TB were statistically significant predictors (P value .000) for adverse treatment outcomes of TB. No difference in adverse outcome was seen in patients who had ART in 8 weeks of ATT and after 8 weeks of ATT.
Conclusion: Early diagnosis of both infections and early ART initiation during the course of ATT are important factors in preventing adverse outcome of Tuberculosis.},
  author       = {Lin, Tharaphi},
  keyword      = {HIV,AIDS,TB,ART,ATT,CD4 cell count,adverse treatment outcomes},
  language     = {eng},
  note         = {Student Paper},
  title        = {Factors associated with adverse treatment outcomes of Tuberculosis among HIV-positive adults in an antiretroviral treatment program in Yangon, Myanmar},
  year         = {2016},
}