Reduction of HIV-associated excess mortality by antiretroviral treatment among tuberculosis patients in Kenya

Mortality from TB continues to be a global public health challenge. TB ranks alongside Human Immunodeficiency Virus (HIV) as the leading infectious causes of death globally. HIV is a major driver of TB related morbidity and mortality while TB is the leading cause of mortality among people living wit...

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Bibliographic Details
Published in:PloS one 2017-11, Vol.12 (11), p.e0188235-e0188235
Main Authors: Onyango, Dickens O, Yuen, Courtney M, Cain, Kevin P, Ngari, Faith, Masini, Enos O, Borgdorff, Martien W
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
AIDS
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Biology and Life Sciences
Care and treatment
Death
Demographic aspects
Diagnosis
Fatalities
Hazard assessment
Highly active antiretroviral therapy
HIV
Human immunodeficiency virus
Kenya
Medicine and Health Sciences
Morbidity
Mortality
Patients
People and Places
Prognosis
Public health
Regression analysis
Risk analysis
Risk factors
Standardization
Tuberculosis
United States
Viruses
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Summary:Mortality from TB continues to be a global public health challenge. TB ranks alongside Human Immunodeficiency Virus (HIV) as the leading infectious causes of death globally. HIV is a major driver of TB related morbidity and mortality while TB is the leading cause of mortality among people living with HIV/AIDS. We sought to determine excess mortality associated with HIV and the effect of antiretroviral therapy on reducing mortality among tuberculosis patients in Kenya. We conducted a retrospective analysis of Kenya national tuberculosis program data of patients enrolled from 2013 through 2014. We used direct standardization to obtain standardized mortality ratios for tuberculosis patients compared with the general population. We calculated the population attributable fraction of tuberculosis deaths due to HIV based on the standardized mortality ratio for deaths among TB patients with HIV compared to TB patients without HIV. We used Cox proportional hazards regression for assessing risk factors for mortality. Of 162,014 patients included in the analysis, 6% died. Mortality was 10.6 (95% CI: 10.4-10.8) times higher among TB patients than the general population; 42% of deaths were attributable to HIV infection. Patients with HIV who were not receiving ART had an over four-fold risk of death compared to patients without HIV (aHR = 4.2, 95% CI 3.9-4.6). In contrast, patients with HIV who were receiving ART had only 2.6 times the risk of death (aHR = 2.6, 95% CI 2.5-2.7). HIV was a significant contributor to TB-associated deaths in Kenya. Mortality among HIV-infected individuals was higher among those not on ART than those on ART. Early initiation of ART among HIV infected people (a "test and treat" approach) should further reduce TB-associated deaths.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0188235