Factors Associated with Early Mortality in HIV-Positive Men and Women Investigated for Tuberculosis at Ethiopian Health Centers

• Published in: PloS one Vol. 11; no. 6; p. e0156602
• Main Authors: Reepalu, Anton, Balcha, Taye Tolera, Skogmar, Sten, Güner, Nuray, Sturegård, Erik, Björkman, Per
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07-06-2016; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; Adults; AIDS; Ambulatory Care Facilities; Analysis; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Arm circumference; Biology and Life Sciences; Clinical Medicine; Coinfection - epidemiology; Coinfection - mortality; Cough; Demographic aspects; Diseases; Ethiopia - epidemiology; Fatalities; Female; Gender; Health; HIV; HIV Infections - drug therapy; HIV Infections - mortality; HIV positive; Human immunodeficiency virus; Humans; Infectious Medicine; Infektionsmedicin; Investigations; Klinisk medicin; Lentivirus; Male; Malnutrition; Medical and Health Sciences; Medical diagnosis; Medicin och hälsovetenskap; Medicine and Health Sciences; Men; Microscopy; Mortality; Mycobacterium; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Factors; Sex Characteristics; Smear; Sputum; Studies; Survival Analysis; Sweden; Tuberculosis; Tuberculosis - epidemiology; Sweden; South Africa; Ethiopia; Africa; Addis Ababa Ethiopia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0156602

Despite increasing access to antiretroviral treatment (ART) in low-income countries, HIV-related mortality is high, especially in the first months following ART initiation. We aimed to evaluate the impact of TB coinfection on early mortality and to assess gender-specific predictors of mortality in a cohort of Ethiopian adults subjected to intensified casefinding for active TB before starting ART.
Prospectively recruited ART-eligible adults (n = 812, 58.6% female) at five Ethiopian health centers were followed for 6 months. At inclusion sputum culture, Xpert MTB/RIF, and smear microscopy were performed (158/812 [19.5%] had TB). Primary outcome was all-cause mortality. We used multivariate Cox models to identify predictors of mortality.
In total, 37/812 (4.6%) participants died, 12 (32.4%) of whom had TB. Karnofsky performance score (KPS) and mid-upper arm circumference (MUAC) were associated with mortality in the whole population. However, the associations were different in men and women. In men, only MUAC remained associated with mortality (adjusted hazard ratio [aHR] 0.71 [95% CI 0.57-0.88]). In women, KPS <80% was associated with mortality (aHR 10.95 [95% CI 2.33-51.49]), as well as presence of cough (aHR 3.98 [95% CI 1.10-14.36]). Cough was also associated with mortality for TB cases (aHR 8.30 [95% CI 1.06-65.14]), but not for non-TB cases.
In HIV-positive Ethiopian adults managed at health centers, mortality was associated with reduced performance score and malnutrition, with different distribution with regard to gender and TB coinfection. These robust variables could be used at clinic registration to identify persons at increased risk of early mortality.