The survival rate of tuberculosis patients in HIV-treated cohort of 2008-2018 in Almaty, Kazakhstan.

INTRODUCTION

HIV/TB comorbidity is responsible for 1.6 million deaths worldwide. HIV/TB control and patients' survival are still among priorities of the national HIV and TB programs. We aimed to evaluate the HIV/TB survival in connection with TB treatment outcomes and factors influencing life duration of the cohort 2008-2018 in Almaty, Kazakhstan.

METHODOLOGY

This retrospective cohort study extracted data for all HIV and pulmonary TB adults coinfected during 2008-2018 in Almaty from national registries to apply descriptive, Kaplan-Meier estimation, and Cox proportional hazards regression model. Survival function for the TB treatment outcomes and factors predicting the probability of survival were tested and described.

RESULTS

The cohort population (n = 521) mean age was 37.4 years with 405 (77.7%) males and 210 (40.3%) marrieds. More than one TB treatment had 181 (34.7%) patients, 291 (55.9%) were smear-positive (SS+), and 423 (81.2%) were on antiretroviral therapy with mean CD4 count 254.22cells/µL. Probability to live longer was higher (128 versus 37 months, p = 0.003; 95% confidence interval (CI) 71.65, 184.35) for those who succeeded in TB treatment compared to "lost to follow-up" and "failed" treatment outcomes. Adjusted Cox regression model death hazard showed association with missing ART treatment (HR: 1.699, 95%CI 1.164, 2.481, p = 0.006) and having CD4 count < 499 (HR 2.398, 95%CI 1.191, 4.830, p < 0.014).

CONCLUSION

TB treatment outcomes, ART treatment, and the CD4 count of HIV/TB coinfected population substantially influence their life duration. The medical decision- and policy-makers should take this into consideration when implementing targeted improvements in the national HIV and TB programs.