FFECT OF TUBERCULOSIS ON THE SURVIVAL OF HUMAN IMMUNODEFICIENCY VIRUS INFECTED ADULTS INITIATED ANTIRETROVIRAL THERAPY IN PUBLIC HOSPITALS OF HARAR AND DIRE DAWA TOWN, EASTERN ETHIOPIA.

Abstract

Background: Tuberculosis is considered to be the leading cause of death in people living with human immunodeficiency virus in low-income countries. Although the effect of tuberculosis on survival of human immunodeficiency virus infected patient is setting specific, in Ethiopia the effect of tuberculosis co-infection on the survival of human immunodeficiency virus patient is poorly understood in antiretroviral therapy era. Objective: To determine the effect of tuberculosis co-infection on survival of human immune deficiency virus infected adults initiated antiretroviral therapy in public hospitals of Harar and Dire Dawa town, eastern Ethiopia, March 1-15, 2019. Methods: Retrospective cohort study was conducted. Human immunodeficiency virus infected patients with and without tuberculosis co-infection was selected by simple random sampling. Kaplan-Meier test was used to estimate the probability of death and the median time to death among patients with tuberculosis and without tuberculosis. Cox proportional hazard model was used to determine the effect of tuberculosis on survival of human immunodeficiency virus infected patients and p-value < 0.05 declares the significance of the variables at 95% confidence level. Result: Out of 566 patients included in the study, 76 were dead with an overall mortality rate of 6.55 per 100 person years (95% CI: 5.28, 8.16 per 100 person years). The incidence of death was 11.04 per 100 person years and 2.52 per 100 person years in tuberculosis co-infected and not tuberculosis co-infected respectively. In multivariable Cox regression analysis, patients with tuberculosis co-infection had 2.19 times higher hazard of death (AHR: 2.19; 95% CI: 1.17, 4.12) compared to those without tuberculosis. Advanced clinical stage (stage IV) (AHR: 3.06; 95% CI: 1.16, 8.09), low CD4+ cell count (<50 cells/mm3) (AHR: 3.7; 95% CI: 2.00, 7.03), and past episode of opportunistic illness other than TB (AHR: 1.65; (95% CI: 1.01, 2.68) were also independent predictors of mortality. Conclusion: Being tuberculosis co-infected at antiretroviral therapy initiation increase the hazard of death approximately by two folds as compared to those without tuberculosis. This illustrates tuberculosis and human immunodeficiency virus collaborative activities need to be strengthened