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Predictors of mortality in adults on treatment for human immunodeficiency virus-associated tuberculosis in Botswana : a retrospective cohort study

dc.contributor.authorMuyaya, Ley Muyayaen_ZA
dc.contributor.authorYoung, Tarynen_ZA
dc.contributor.authorLoveday, Marianen_ZA
dc.date.accessioned2018-05-09T07:38:09Z
dc.date.available2018-05-09T07:38:09Z
dc.date.issued2018
dc.identifier.citationMuyaya, L. M., Young, T. & Loveday, M. 2018. Predictors of mortality in adults on treatment for human immunodeficiency virus-associated tuberculosis in Botswana: a retrospective cohort study. Medicine, 97(16):e0486, doi:10.1097/MD.0000000000010486
dc.identifier.issn1536-5964 (online)
dc.identifier.issn0025-7974 (print)
dc.identifier.otherdoi:10.1097/MD.0000000000010486
dc.identifier.urihttp://hdl.handle.net/10019.1/103978
dc.descriptionCITATION: Muyaya, L. M., Young, T. & Loveday, M. 2018. Predictors of mortality in adults on treatment for human immunodeficiency virus-associated tuberculosis in Botswana: a retrospective cohort study. Medicine, 97(16):e0486, doi:10.1097/MD.0000000000010486.
dc.descriptionThe original publication is available at http://journals.lww.com/md-journal
dc.descriptionPublication of this article was funded by the Stellenbosch University Open Access Fund.
dc.description.abstractMortality in patients with human immunodeficiency virus (HIV)-associated tuberculosis (TB) is high, particularly in sub-Saharan Africa. This study aimed to compare mortality and predictors of mortality in those who were antiretroviral therapy (ART) naïve to those with prior ART exposure. This retrospective cohort study was conducted in Serowe/Palapye District, Botswana, a predominantly urban district with a large burden of HIV-associated TB with a high case fatality. Between January 1, 2013 and December 31, 2013, patients confirmed with HIV-associated TB were enrolled and followed up. Kaplan–Meier and Cox proportional hazard modeling was undertaken to identify predictors of mortality, with ART initiation included as time-updated variable. Among the 300 patients enrolled in the study, 131 had started ART before TB diagnosis (44%). There were 45 deaths. There was no difference in mortality between ART-naïve patients and those with prior ART exposure. In the multivariate analysis, no ART use during TB treatment (hazard ratio [HR]=5.6, 95% confidence interval [CI]=2.9–11; P<.001), opportunistic infections other than TB (HR=8.5, 95% CI=4–18.4; P=.013), age ≥60 years (HR=4.8, 95% CI=1.8–13; P=.002), hemoglobin <10g/dL (HR=2.4, 95% CI=1.3–4.5) and hepatotoxicity (HR=5, 95% CI=1.6–17; P=.007) were associated with increased mortality. In the subgroup analysis, among ART-naïve patients, no ART use during TB treatment (HR=8.1, 95% CI=3.4–19.4; P<.001), opportunistic infections other than TB (HR=16, 95% CI=6.2–42; P<.001), and hepatotoxicity (HR=8.3, 95% CI=2.6–27; P<.001) were associated with mortality. Among patients with prior ART exposure, opportunistic infections other than TB (HR=6, 95% CI=2.6–27; P<.001) were associated with mortality. Mortality in patients with HIV-associated TB is still high. To reduce mortality, close clinical monitoring of patients together with initiation of ART during TB treatment is indicated.en_ZA
dc.description.urihttps://journals.lww.com/md-journal/Fulltext/2018/04200/Predictors_of_mortality_in_adults_on_treatment_for.54.aspx
dc.format.extent6 pages
dc.language.isoen_ZAen_ZA
dc.publisherWolters Kluwer Health
dc.subjectDeathsen_ZA
dc.titlePredictors of mortality in adults on treatment for human immunodeficiency virus-associated tuberculosis in Botswana : a retrospective cohort studyen_ZA
dc.typeArticleen_ZA
dc.description.versionPublisher's version
dc.rights.holderAuthors retain copyright


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