Predictors of death during tuberculosis treatment in TB/HIV co-infected patients in Malaysia

Ismail, I. and Bulgiba, A. (2013) Predictors of death during tuberculosis treatment in TB/HIV co-infected patients in Malaysia. PLoS ONE, 8 (8). ISSN 1932-6203, DOI https://doi.org/10.1371/journal.pone.0073250.

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Abstract

Background: Mortality among TB/HIV co-infected patients is still high particularly in developing countries. This study aimed to determine the predictors of death in TB/HIV co-infected patients during TB treatment. Methods: We reviewed medical records at the time of TB diagnosis and subsequent follow-up of all newly registered TB patients with HIV co-infection at TB clinics in the Institute of Respiratory Medicine and three public hospitals in the Klang Valley between January 2010 and September 2010. We reviewed these medical records again twelve months after their initial diagnosis to determine treatment outcomes and survival. We analysed using Kaplan-Meier and conducted multivariate Cox proportional hazards analysis to identify predictors of death during TB treatment in TB/HIV co-infected patients. Results: Of the 227 patients studied, 53 (23.3) had died at the end of the study with 40 of deaths within two months of TB diagnosis. Survival at 2, 6 and 12 months after initiating TB treatment were 90.7, 82.8 and 78.8 respectively. After adjusting for other factors, death in TB/HIV co-infected patients was associated with being Malay (aHR 4.48; 95 CI 1.73-11.64), CD4 T-lymphocytes count <200 cells/mu l (aHR 3.89; 95 CI 1.20-12.63), three or more opportunistic infections (aHR 3.61; 95 CI 1.04-12.55), not receiving antiretroviral therapy (aHR 3.21; 95 CI 1.76-5.85) and increase per 103 total white blood cell count per microliter (aHR 1.12; 95 CI 1.05-1.20) Conclusion: TB/HIV co-infected patients had a high case fatality rate during TB treatment. Initiation of antiretroviral therapy in these patients can improve survival by restoring immune function and preventing opportunistic infections.

Item Type:	Article
Funders:	UNSPECIFIED
Additional Information:	ISI Document Delivery No.: 200UV Times Cited: 0 Cited Reference Count: 41 Ismail, Ismawati Bulgiba, Awang University of Malaya/Ministry of Higher Education (UM/MOHE) High Impact Research Grant E000010-20001; University of Malaya Research Grant PS230/2010A This work is part of the STeMM Programme supported by the University of Malaya/Ministry of Higher Education (UM/MOHE) High Impact Research Grant (Grant number E000010-20001) and the University of Malaya Research Grant (PS230/2010A). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Public library science San francisco
Uncontrolled Keywords:	Human-immunodeficiency-virus active antiretroviral therapy hiv-associated tuberculosis pulmonary tuberculosis treatment outcomes drug-resistance tb treatment survival mortality impact
Subjects:	R Medicine
Divisions:	Faculty of Medicine
Depositing User:	Ms Haslinda Lahuddin
Date Deposited:	15 Apr 2014 08:10
Last Modified:	05 Jul 2017 01:33
URI:	http://eprints.um.edu.my/id/eprint/9838

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