Tuberculosis doubles risk of death in patients on ART

Coinfection of tuberculosis (TB) among people with HIV initiating antiretroviral therapy (ART) aggravates the risk of death, a recent study has found.

Researchers conducted a retrospective cohort analysis of 566 people living with HIV who had initiated ART between January 1, 2014 and June 30, 2018. TB coinfection was defined as an active pulmonary or extra-pulmonary infection at or within the first three months of ART initiation.

Of the study participants, 283 were deemed to be coinfected with TB at ART. A total of 76 deaths occurred over the duration of the study, yielding an overall mortality rate of 13.4 percent). Most of the deaths (65.7 percent) occurred in the first 6 months.

In the TB coinfected subgroup, the incidence rate of death was 11.04 per 100 person-year observation of follow-up. In the non-coinfected comparators, the corresponding rate was 2.52 per 100 person-year observation. Median time to death in the respective subgroups was 2.5 and 12.2 months.

Actuarial life table analysis found that at 1 year after ART initiation, the survival probabilities of those with vs without TB coinfection were 81.6 percent and 97.1 percent, respectively. These dropped to 69 percent and 93 percent at 60 months, respectively.

Cox proportional hazards analysis confirmed that TB coinfection was a significant risk factor for death, increasing such likelihood by more than twofold (adjusted hazard ratio, 2.19, 95 percent confidence interval, 1.17–4.12; p=0.014).