Bigna Jean Joel R, Noubiap Jean Jacques N, Agbor Ako A, Plottel Claudia S, Billong Serge Clotaire, Ayong André Patrick R, Koulla-Shiro Sinata
Department of Epidemiology and Public Health, Pasteur Center of Cameroon, Yaoundé, Cameroon.
Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; Medical Diagnosis Center, Yaoundé, Cameroon.
PLoS One. 2015 Jul 27;10(7):e0132394. doi: 10.1371/journal.pone.0132394. eCollection 2015.
Understanding contributors to mortality during the initial phase of tuberculosis (TB) treatment in patients co-infected with HIV would guide targeted interventions to improve survival. The aim of this study was to ascertain the incidence of death during the initial 2 months (new cases) and 3 months (retreatment cases) of TB treatment and to assess correlates of mortality in HIV co-infected patients.
We conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify co-infected TB/HIV inpatients aged 15 years and older who died during TB treatment. Death was defined as any death occurring during TB treatment, as per World Health Organization recommendations. We collected socio-demographic, clinical and laboratory data. We conducted multivariable logistic binary regression analysis to identify factors associated with death during the intensive phase of TB treatment. Magnitudes of associations were expressed by adjusted odds ratio (aOR) with 95% confidence interval. A p value < 0.05 was considered statistically significant.
The 99 patients enrolled had a mean age of 39.5 (standard deviation 10.9) years and 53% were male. Patients were followed for 276.3 person-months of observation (PMO). Forty nine patients were died during intensive phase of TB treatment. Death incidence during the intensive phase of TB treatment was 32.2 per 100 PMO. Having a non-AIDS comorbidity (aOR 2.47, 95%CI 1.22-5.02, p = 0.012), having extra-pulmonary TB (aOR 1.89, 95%CI 1.05-3.43, p = 0.035), and one year increase in duration of known HIV infection (aOR 1.23, 95%CI 1.004-1.49) were independently associated with death during the intensive phase of TB treatment.
Mortality incidence during intensive phase of TB treatment was high among TB/HIV co-infected patients during TB treatment; and strongly associated with extra pulmonary TB suggesting advanced stage of immunosuppression and non-AIDS comorbidities. Early HIV diagnosis and care and good management of non-comorbidities can reduce this incidence.
了解合并感染艾滋病毒的患者在结核病（TB）治疗初始阶段的死亡因素，将有助于指导针对性干预措施以提高生存率。本研究的目的是确定结核病治疗最初2个月（新发病例）和3个月（复治病例）期间的死亡发生率，并评估合并感染艾滋病毒患者的死亡相关因素。
我们于2006年1月至2013年12月在喀麦隆雅温得中心医院开展了一项基于医院的回顾性队列研究。我们查阅医疗记录，以确定在结核病治疗期间死亡的15岁及以上的合并感染结核/艾滋病毒的住院患者。根据世界卫生组织的建议，死亡定义为结核病治疗期间发生的任何死亡。我们收集了社会人口学、临床和实验室数据。我们进行了多变量逻辑二元回归分析，以确定与结核病治疗强化期死亡相关的因素。关联强度用调整后的优势比（aOR）及95%置信区间表示。p值<0.05被认为具有统计学意义。
纳入的99例患者的平均年龄为39.5（标准差10.9）岁，53%为男性。患者的观察随访时间为276.3人月（PMO）。49例患者在结核病治疗强化期死亡。结核病治疗强化期的死亡发生率为每100人月32.2例。患有非艾滋病合并症（aOR 2.47，95%CI 1.22 - 5.02，p = 0.012）、肺外结核（aOR 1.89，95%CI 1.05 - 3.43，p = 0.035）以及已知艾滋病毒感染时间增加一年（aOR 1.23，95%CI 1.004 - 1.49）与结核病治疗强化期死亡独立相关。
结核病/艾滋病毒合并感染患者在结核病治疗强化期的死亡率较高；并且与肺外结核密切相关，提示免疫抑制晚期和非艾滋病合并症。早期艾滋病毒诊断与治疗以及非合并症的良好管理可降低这一发生率。
