Tuberculosis Incidence and Mortality Rates Among People Living with HIV Receiving Antiretroviral Therapy at the Buea Regional Hospital: A Seven Year Retrospective Study
International Journal of HIV/AIDS Prevention, Education and Behavioural Science
Volume 5, Issue 2, December 2019, Pages: 82-90
Received: May 20, 2019;
Accepted: Jun. 25, 2019;
Published: Jul. 31, 2019
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Henry Dilonga Meriki, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon; TB Diagnostic Unit, Regional Hospital Buea, Buea, Cameroon; Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
Kah Emmanuel Nji, TB Diagnostic Unit, Regional Hospital Buea, Buea, Cameroon; Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
Kukwah Anthony Tufon, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon; TB Diagnostic Unit, Regional Hospital Buea, Buea, Cameroon
Yaoh Adolf Tah, Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
Pascal Nji Atanga, Cameroon Baptist Convention Health Service, Mutengene, Cameroon
Anna Longdoh Njunda, Department of Medical Microbiology and Parasitology, University of Buea, Buea, Cameroon
Irene Ane Anyangwe, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
Introduction: The use of antiretroviral therapy (ART) has dramatically decreased HIV-associated morbidity and mortality in high-and low-income countries with a corresponding reduction in tuberculosis (TB) incidence. Nevertheless, the risk of TB remains substantially higher in people living with HIV (PLHIV) compared to non-HIV infected individuals. In Cameroon, free ART was introduced in 2007 and our understanding of the possible role of ART in reducing HIV-associated TB remains limited. We assessed TB incidence, mortality and risk factors for TB and mortality among PLHIV treated at Buea Regional Hospital between 2008 and 2014. Materials and Methods: In a retrospective study we reviewed the records of 1,477 HIV patients on ART. The data was entered and analysed using SPSS version 21. Bivariate and Multivariate logistic regression analysis were used to determine the risk factors associated with TB and mortality occurrences at 5% significance level. Results: Of the 1477 patients’ records that was reviewed, females (70.7%) constituted a greater proportion. Majority of the participants (60.5%) were between the ages 21-40 years (mean: 37.5 ± 11.5. SD). A total of 209 patients developed TB giving an overall TB incidence density rate 4.25/100PYR (95% CI: 2.47-6.46). There was an increasing trend in the incidence of TB over the years from 1.69 (95% CI: 0.72-1.98) in 2008 to 19.63 (95% CI: 7.36-21.20) in 2014. The overall mortality rate was 12.4% (183/1477) of which 38.8% (71/183) of them were on TB treatment or previously treated for TB. In a multivariate analysis, low CD4 cells level at ART initiation (AOR: 1.3, 95% CI: 1.11-.2.10), WHO HIV clinical stage 3 and 4 (AOR: 1.52, 95% CI: 1.01-2.22) were significantly associated with increase odds of TB occurrence. Conclusion: Even in the era of HAART, TB still remains a significant cause of mortality among PLHIV and therefore efforts should be scaled-up for early diagnosis and prompt treatment of TB.
Henry Dilonga Meriki,
Kah Emmanuel Nji,
Kukwah Anthony Tufon,
Yaoh Adolf Tah,
Pascal Nji Atanga,
Anna Longdoh Njunda,
Irene Ane Anyangwe,
Tuberculosis Incidence and Mortality Rates Among People Living with HIV Receiving Antiretroviral Therapy at the Buea Regional Hospital: A Seven Year Retrospective Study, International Journal of HIV/AIDS Prevention, Education and Behavioural Science.
Vol. 5, No. 2,
2019, pp. 82-90.
Habib AG. A clinical and epidemiologic update on the interaction between tuberculosis and human immunodeficiency virus infection in adults. Ann Afr Med. 2009; 8: 147–55. doi: 10.4103/1596-3519.57236.
WHO. Global Tuberculois Report 2015- Executive Summary. World Heal Organ. 2015; 1–3. doi: 10.1037/e530172011-002.
World Health Organization. Global Tuberculosis Report [Internet]. WHO. 2013. doi: 978 92 4 156450 2.
Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med. 2003; 163: 1009–21. doi: 10.1001/archinte. 163.9.1009.
Wang L, Liu W, Wang Y, Wu Z. HIV prevalence among pulmonary tuberculosis patients in Guangxi, China. J Acquir Immune Defic Syndr. 2010; 53 Suppl 1: S61-5. doi: 10.1097/QAI. 0b013e3181c7db2e.
Jaryal A, Raina R, Sarkar M, Sharma A. Manifestations of tuberculosis in HIV/AIDS patients and its relationship with CD4 count. Lung India. 2011; 28: 263–6. doi: 10.4103/0970-2113.85687.
Chaimay B, Woradet S, Chantutanon S, Phuntara S, Suwanna K. Mortality among HIV/AIDS patients coinfected with Mycobacterium tuberculosis in southern Thailand. Southeast Asian J Trop Med Public Health. 2013; 44: 641–648. Available: http://www.ncbi.nlm.nih.gov/pubmed/24050098.
WHO. HIV-Associated Tuberculosis. Eur Med J. 2015; 60: 60–70.
WHO. Antiretroviral therapy for HIV infection in adults and adolescents. Recommendations for a public health approach: 2010 revision. World Heal Organ. 2010.
Mor Z, Lidji M, Cedar N, Grotto I, Chemtob D. Tuberculosis incidence in HIV/AIDS patients in Israel, 1983-2010. PLoS One. 2013; 8. doi: 10.1371/journal.pone. 0079691.
Wasa Alibe Ahmed RKP and BYB. Incidence of Tuberculosis among Human Immunodeficiency Virus (HIV) patients attending General Hospital Bajoga\n. IOSR J Pharm Biol Sci. 2013; 7: 69–72. Available: http://www.iosrjournals.org/iosr-jpbs/papers/Vol7-issue5/L0756972.pdf?id=6973.
Carvalho BM De, Monteiro AJ, Pires Neto RDJ, Grangeiro TB, Frota CC. Factors related to HIV/tuberculosis coinfection in a Brazilian reference hospital. Braz J Infect Dis. 2008; 12: 281–286. doi: 10.1590/S1413-86702008000400005.
Mukadi YD, Maher D, Harries A. Tuberculosis case fatality rates in high HIV prevalence populations in sub-Saharan Africa. AIDS. 2001; 15: 143–152. doi: 10.1097/00002030-200101260-00002.
Batista J d AL, de Albuquerque M de FPM, Maruza M, Ximenes RA de A, Santos ML, Montarroyos UR, et al. Incidence and Risk Factors for Tuberculosis in People Living with HIV: Cohort from HIV Referral Health Centers in Recife, Brazil. PLoS One. 2013; 8. doi: 10.1371/journal.pone. 0063916.
Libite PR, Kelodjoue S, Dzossa a D, Fomo M a, Niekou R, Al. E, et al. Republic of Cameroon: Demographic and Health Survey and Multiple Indicator Cluster Survey (DHS-MICS) 2011. / République du Cameroun: enquête démographique et de santé et à indicateurs multiples (EDS-MICS) 2011. [Internet]. République du Cameroun: enquête démographique et de santé et à indicateurs multiples (EDS-MICS) 2011. 2012. Available: http://www.measuredhs.com/pubs/pdf/FR260/FR260.pdf.
Howard AA, El-Sadr WM. Integration of tuberculosis and HIV services in sub-Saharan Africa: lessons learned. Clin Infect Dis. 2010; 50 Suppl 3: S238-44. doi: 10.1086/651497.
Muga R, Ferreros I, Langohr K, de Olalla PG, Romero J Del, Quintana M, et al. Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART. AIDS. 2007; 21: 2521–2527. doi: 10.1097/QAD. 0b013e3282f1c933.
Dalbo M, Tamiso A, Dalbo M, Tamiso A. Incidence and Predictors of Tuberculosis among HIV/AIDS Infected Patients: A Five-Year Retrospective Follow-Up Study. Adv Infect Dis. 2015; 6: 70–81. doi: 10.4236/aid. 2016.62010.
Hanna DB, Gupta LS, Jones LE, Thompson DM, Kellerman SE, Sackoff JE. AIDS-defining opportunistic illnesses in the HAART era in New York City. AIDS Care. 2007; 19: 264–272. doi: 10.1080/09540120600834729.
Lawn SD, Badri M, Wood R. Tuberculosis among HIV-infected patients receiving HAART: long term incidence and risk factors in a South African cohort. AIDS. 2005. pp. 2109–2116. doi: 10.1097/01.aids. 0000194808.20035.c1.
Charurat M, Oyegunle M, Benjamin R, Habib A, Eze E, Ele P, et al. Patient Retention and Adherence to Antiretrovirals in a Large Antiretroviral Therapy Program in Nigeria : A Longitudinal Analysis for Risk Factors. PLoS One. 2010; 5: e10584. doi: 10.1371/journal.pone. 0010584.
Elenga N, Georger-Sow M-T, Messiaen T, Lamaurie I, Favre I, Nacher M, et al. Incidence, predictive factors and prognosis of tuberculosis among patients with hiv infection in guadeloupe 1988-2009. J AIDS Clin Res. 2013; 4. Available: http://www.scopus.com/inward/record.url?eid=2-s2.0-84884937610&partnerID=40&md5=8bbef65ad4b7956e911318bc876b444f.
Gopi PG, Subramani R, Santha T, Kumaran PP, Kumaraswami V, Narayanan PR. Relationship of ARTI to incidence and prevalence of tuberculosis in a district of south India. International Journal of Tuberculosis and Lung Disease. 2006. pp. 115–117.
Murrison LB, Martinson N, Moloney RM, Msandiwa R, Mashabela M, Samet JM, et al. Tobacco smoking and tuberculosis among men living with hiv in johannesburg, South Africa: A case-control study. PLoS One. 2016; 11: e0167133. doi: 10.1371/journal.pone. 0167133.
Karo B, Haas W, Kollan C, Gunsenheimer-Bartmeyer B, Hamouda O, Fiebig L. Tuberculosis among people living with HIV/AIDS in the German ClinSurv HIV Cohort: long-term incidence and risk factors. BMC Infect Dis. BMC Infectious Diseases; 2014; 14: 148. doi: 10.1186/1471-2334-14-148.
Lawn SD, Bekker L-G, Wood R. How effectively does HAART restore immune responses to Mycobacterium tuberculosis? Implications for tuberculosis control. Aids. 2005; 19: 1113–1124. doi: 10.1097/01.aids. 0000176211.08581.5a.
Girardi E, Antonucci G, Vanacore P, Palmieri F, Matteelli a, Iemoli E, et al. Tuberculosis in HIV-infected persons in the context of wide availability of highly active antiretroviral therapy. Eur Respir J Off J Eur Soc Clin Respir Physiol. 2004; 24: 11–17. doi: 10.1183/09031936.04.00109303.
Taarnhøj G a, Engsig FN, Ravn P, Johansen IS, Larsen CS, Røge B, et al. Incidence, risk factors and mortality of tuberculosis in Danish HIV patients 1995-2007. BMC Pulm Med. 2011; 11: 26. doi: 10.1186/1471-2466-11-26.
Pennap GR, Makpa S, Ogbu S. PREVALENCE OF HIV/AIDS AMONG TUBERCULOSIS PATIENTS SEEN IN A RURAL CLINIC IN NIGERIA. Trakia J Sci. 2011; 9: 40–44. Available: http://www.uni-sz.bg.
Nwobu GO, Okodua MA, Tatfeng YM. Comparative study of HIV associated pulmonary tuberculosis in chest clinics from two regions of Edo state, Nigeria. JHAS. 2004; 3: 1–7. Available: https://pdfs.semanticscholar.org/191b/8271c50b0ac1f7933b1ecc06966f09e360c2.pdf.