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Survival and risk factors of mortality among patients with TB/HIV coinfection in Kigali City, Rwanda: a retrospective cohort study (2019-2024).
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Ndabana Didier, Nikwigize Solange, Murego Felix, Ndayisenga Jerome, Migambi Patrick, Andegiorgish Amanuel Kidane
Аннотация
BACKGROUND: Tuberculosis (TB) is still the most common cause of mortality among people living with HIV (PLHIV) worldwide. However, in Rwanda, no study has specifically assessed the survival and risk factors for mortality among patients with TB/HIV co-infection in urban settings such as Kigali city. This study aims to determine the survival probability and identify risk factors for mortality among patients with TB/HIV coinfection in Kigali City, Rwanda.
METHODS: A retrospective cohort study was conducted among 1,966 patients aged (≥ 15 years) with TB/HIV co-infection who were receiving antiretroviral therapy (ART) at the time of TB diagnosis and were enrolled at the initiation of treatment for drug-susceptible tuberculosis at 48 health facilities in Kigali between July 2019 and March 2024. Data were extracted from the e-TB system and patients' medical records. The survival probability up to 168 days was estimated via the Kaplan-Meier method. Cox proportional hazards regression was used to predict mortality. Statistical significance was set at p < 0.05.
RESULTS: The median age of the patients was 39 years (IQR: 33-46), and 66.0% were male. A total of 264 patients (13.4%, 95% CI: 11.9-15.0) died, and 78.8% of the deaths occurred within the first 56 days of follow-up. The overall survival probability was 86.6% (95% CI: 84.9-88.0). Significant predictors of mortality included age ≥ 45 years (adjusted hazard ratio [aHR] = 2.21; 95% CI: 1.18-4.11), no receipt of cotrimoxazole preventive therapy (CPT) (aHR: 1.65; 95% CI: 1.29-2.13), the presence of comorbidities(including diabetes mellitus, hypertension, asthma, chronic liver disease, chronic kidney disease, malignancy, and other chronic illnesses) (aHR: 3.18; 95% CI: 2.27-4.45), no receipt of tuberculosis preventive treatment (TPT) (aHR: 1.87; 95% CI: 1.38-2.54), undernutrition (aHR: 2.72; 95% CI: 2.12-3.50), fair ART adherence (aHR: 1.89; 95% CI: 1.25-2.87), low CD4 count < 200 cells/mm³ (aHR: 2.30; 95% CI: 1.74-3.05) and extrapulmonary TB (aHR: 1.62; 95% CI: 1.15-2.28).
CONCLUSION: Mortality among patients with TB/HIV-coinfected in Kigali remains high, particularly during the early treatment period. Predictors of mortality included older age, lack of TPT and CPT, comorbidities, undernutrition, fair ART adherence, low CD4 count and extrapulmonary TB. Increasing TB/HIV integrated care through improved adherence support, nutritional supplementation, comorbidity management, increased uptake of cotrimoxazole and TPT, and timely interventions are critical to reduce mortality.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: A retrospective cohort study was conducted among 1,966 patients aged (≥ 15 years) with TB/HIV co-infection who were receiving antiretroviral therapy (ART) at the time of TB diagnosis and were enrolled at the initiation of treatment for drug-susceptible tuberculosis at 48 health facilities in Kigali between July 2019 and March 2024. Data were extracted from the e-TB system and patients' medical records. The survival probability up to 168 days was estimated via the Kaplan-Meier method. Cox proportional hazards regression was used to predict mortality. Statistical significance was set at p < 0.05.
RESULTS: The median age of the patients was 39 years (IQR: 33-46), and 66.0% were male. A total of 264 patients (13.4%, 95% CI: 11.9-15.0) died, and 78.8% of the deaths occurred within the first 56 days of follow-up. The overall survival probability was 86.6% (95% CI: 84.9-88.0). Significant predictors of mortality included age ≥ 45 years (adjusted hazard ratio [aHR] = 2.21; 95% CI: 1.18-4.11), no receipt of cotrimoxazole preventive therapy (CPT) (aHR: 1.65; 95% CI: 1.29-2.13), the presence of comorbidities(including diabetes mellitus, hypertension, asthma, chronic liver disease, chronic kidney disease, malignancy, and other chronic illnesses) (aHR: 3.18; 95% CI: 2.27-4.45), no receipt of tuberculosis preventive treatment (TPT) (aHR: 1.87; 95% CI: 1.38-2.54), undernutrition (aHR: 2.72; 95% CI: 2.12-3.50), fair ART adherence (aHR: 1.89; 95% CI: 1.25-2.87), low CD4 count < 200 cells/mm³ (aHR: 2.30; 95% CI: 1.74-3.05) and extrapulmonary TB (aHR: 1.62; 95% CI: 1.15-2.28).
CONCLUSION: Mortality among patients with TB/HIV-coinfected in Kigali remains high, particularly during the early treatment period. Predictors of mortality included older age, lack of TPT and CPT, comorbidities, undernutrition, fair ART adherence, low CD4 count and extrapulmonary TB. Increasing TB/HIV integrated care through improved adherence support, nutritional supplementation, comorbidity management, increased uptake of cotrimoxazole and TPT, and timely interventions are critical to reduce mortality.
CLINICAL TRIAL NUMBER: Not applicable.