Clinical Presentation, Treatment Outcome and Survival of HIV Positive Tb Patients on Short Course Dots in Hawassa Health Center
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Date
2010-06
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Addis Abeba Universty
Abstract
Background information: In contrast to, many initiatives implemented to tackle Tuberculosis, many
countries have not so far reached the targets set by WHO. The main reason mentioned so far was the
impact of HIV infection. Therefore, it is essential to determine the impact of HIV/AIDs on the clinical
presentation and treatment outcome of tuberculosis locally.
Objectives: To compare clinical presentation, treatment outcome of TB and on treatment survival
among HIV positive and negative TB patients who are through (DOTs).
Methods: A retrospective cohort study design was employed to compare the clinical presentation of TB
and its respective treatment outcome between the exposed; HIV positive (n=370) and non exposed; HIV
negative TB patients (n=370) who were through the short course DOTs in Hawassa Health Center from
2006-2010. Patient’s HIV status during the diagnosis of TB or initiation of DOTs was considered as an
exposure and TB treatment outcome was considered as the outcome variables. Standard WHO definition,
is used to classify tuberculosis cases and TB treatment outcomes.
Results: Smear negative PTB was significantly the frequent presentation, 0.32, 95%CI (0.25, 0.39;
Z=8.76, P=0.000) among HIV positive study subjects, while significant difference in proportion of smear
positive PTB; (-0.26; 95%CI (-0.33 -0.19; Z=-6.25, P=0.000) was in favor of HIV negative individuals.
Compared to HIV negative TB patients ,cure rate was substantially lower in HIV positive TB patients
(73% vs. 87.9%, z=-2.5, P=0.04), and the risk of death was statistically higher among TB/HIV co infected
patients; AHR=1.6, 95%CI(1.01-2.6) during the course of DOTs. Regarding survival of TB patients, the
survival probability was lower for HIV/TB co infected patients (Log rank test= 6.90, df= 2,P=
0.008).When adjusted for covariates, the survival probability is below 15% for HIV positive but above
85% in HIV negative TB patients at the end of DOTs period(8th month). The independent predictors of
death, while on treatment are age, weight and HIV infection.
Conclusion: On TB treatment survival probability and cure rate are substantially lower in HIV infected
TB patients due to an increased death and unfavorable treatment out comes for the former and the later
respectively. Therefore targeted and comprehensive management of TB should be considered in this
group of patients.
Key words: Clinical presentation, treatment outcome, survival of TB patients, Hawassa health center
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Clinical presentation, treatment outcome, survival of TB patients, Hawassa health center