Effect of Tuberculosis on Mortality and its Predictors among HIV-Infected Adults on Antiretroviral Therapy: A Multicentre Retrospective Cohort Study in Awi Zone Public Hospitals, Northwest Ethiopia, 2024

Abstract

Background: The impact of tuberculosis (TB) on the mortality of people with human immunodeficiency virus (PWH) is high in Sub-Saharan Africa. Therefore, this study aimed to assess the effect of TB on mortality and its predictors among HIV-infected adults on anti-retroviral therapy (ART) at Awi Zone Public Hospitals. Method: A hospital-based retrospective cohort study was conducted among HIV-infected adults on ART with tuberculosis and without tuberculosis from January 1, 2018, to December 30, 2022, at Awi Zone public hospitals. Computer-generated simple random sampling was used to select 642 adults. Then, 321 TB/HIV co-infected and 321 tuberculosis-free PWH were recruited and followed for the occurrence of death. The Cox proportional hazard assumptions were not satisfied. Weibull regression was the best-fitted model after being selected by Akaike information criterion. An adjusted hazard ratio (AHR) with a 95% CI at P-value < 0.05 was used to declare significant predictors of mortality. Result: A total of 642 HIV-infected patients were followed for 1571.9 person-years of observation (PYO). Out of 642, 117 (18.22%) died with an overall mortality rate of 7.44 per 100-PYO (95% CI: 6.21, 8.92 per 100 PYO). The incidence rate of death in TB co-infected and TB-free patients was 10.92 per 100 PYO and 4.26 per 100 PYO, respectively. Age 35-44 (AHR=2.58; 95% CI: 1.15–5.77), age 45 years and older (AHR=3.89; 95% CI: 2.12–7.13), co-infected with TB(AHR= 2.56; 95% CI: 1.72–3.82) being ambulatory (AHR =3.11, 95 % CI: 1.42–6.79), bedridden (AHR =2.53; 95 % CI: 1.20–5.32), WHO stage IV (AHR= 2.55, 95% CI: 1.01-6.50), anemia (AHR = 2.97; 95% CI: 1.65–5.37), CD4 Count <100 (AHR= 3.95; 95% CI: 1.68- 9.28), opportunistic infections (AHR = 4.78; 95% CI:2.02-11.34), cotrimoxazole use (AHR = 0.43; 95% CI: 0.24– 0.78), changed ART regimens (AHR= 0.39; 95% CI: 0.24-0.65) and poor adherence (AHR=4.28; 95% CI: 1.77-10.36) were significantly associated with mortality among HIV infected adult patients. Conclusions: The mortality rate among TB/HIV co-infected people is nearly three times higher than tuberculosis-free PWH. Many clinical factors were significant predictors of mortality. Therefore, clinicians and HIV program managers need to design interventions locally