Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA.
Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Sci Rep. 2024 Oct 11;14(1):23834. doi: 10.1038/s41598-024-68605-2.
Little is known regarding the relationship between common comorbidities in persons with tuberculosis (TB) (including human immunodeficiency virus [HIV], diabetes, and hepatitis C virus [HCV]) and post-TB mortality. We conducted a retrospective cohort study among persons who initiated treatment for rifampicin-resistant or multi/extensively drug-resistant (RR or M/XDR) TB reported to the country of Georgia's TB surveillance during 2009-2017. Exposures included HIV serologic status, diabetes, and HCV status. Our outcome was all-cause post-TB mortality determined by cross-validating vital status with Georgia's death registry through November 2019. We estimated adjusted hazard rate ratios (aHR) and 95% confidence intervals (CI) of post-TB mortality among participants with and without comorbidities using cause-specific hazard regressions. Among 1032 eligible participants, 34 (3.3%) died during treatment and 87 (8.7%) died post-TB treatment. The median time to post-TB death was 21 months (interquartile range 7-39) after TB treatment. After adjusting for confounders, the hazard rates of post-TB mortality were higher among participants with HIV co-infection (aHR = 3.74, 95%CI 1.77-7.91) compared to those without HIV co-infection. In our cohort, post-TB mortality occurred most commonly in the first 3 years post-TB treatment. Linkage to care for common TB comorbidities post-treatment may reduce post-TB mortality rates.
关于结核病（TB）患者（包括人类免疫缺陷病毒[HIV]、糖尿病和丙型肝炎病毒[HCV]）常见合并症与 TB 后死亡率之间的关系知之甚少。我们对格鲁吉亚 TB 监测报告的 2009 年至 2017 年期间开始接受利福平耐药或多/广泛耐药（RR 或 M/XDR）TB 治疗的患者进行了回顾性队列研究。暴露因素包括 HIV 血清学状态、糖尿病和 HCV 状态。我们的结局是通过与格鲁吉亚死亡登记处交叉验证至 2019 年 11 月的所有原因 TB 后死亡率。我们使用特定原因的危险回归估计了有和没有合并症的参与者的 TB 后死亡率的调整后的危险率比（aHR）和 95%置信区间（CI）。在 1032 名合格参与者中，34 名（3.3%）在治疗期间死亡，87 名（8.7%）在 TB 治疗后死亡。TB 治疗后 TB 后死亡的中位时间为 21 个月（四分位间距 7-39）。在调整混杂因素后，与未合并 HIV 感染的参与者相比，合并 HIV 感染的参与者的 TB 后死亡率的危险率更高（aHR=3.74，95%CI 1.77-7.91）。在我们的队列中，TB 后死亡率最常见于 TB 治疗后 3 年内发生。在治疗后对常见 TB 合并症进行护理衔接可能会降低 TB 后死亡率。
