A Description of Mortality Associated with IPT plus ART Compared to ART Alone among HIV-Infected Individuals in Addis Ababa, Ethiopia: A Cohort StudyReportar como inadecuado




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Background

Tuberculosis TB is the most common human immunodeficiency virus HIV associated opportunistic infection. It is the leading cause of death in HIV-infected individuals in sub-Saharan Africa. Anti-retroviral therapy ART and isoniazid preventive therapy IPT are the two useful TB preventative strategies available to reduce TB among people living with HIV PLHIV. Therefore, the aim of this study is to compare mortality associated with IPT taken together with ART, as well as ART alone, among PLHIV.

Methods

A retrospective cohort study was undertaken at Tikur Anbessa Specialized Hospital TASH and Zewditu Memorial Hospital ZMH on 185 patients receiving IPT 6 months plus ART and 557 patients receiving ART alone. Mortality rates MR per 100 person-years PYs were used to compare mortality rates amongst the groups. Time-to-death and survival probabilities of the patients were determined using the Kaplan Meier Method. The Cox Proportional Hazard Model was employed to estimate the effect of IPT plus ART on survival of PLHIV.

Results

The mortality cases noted in patients treated by IPT plus ART versus ART alone were 18 4.5 cases-100 PYs and 116 10 cases-100 PYs, respectively. In reference to the ART alone, the IPT plus ART reduced the likelihood of death significantly aHR 0.48; 95% CI 0.38–0.69 and median time to death was about 26 months IQR 19–34. Moreover, WHO stage IV aHR 2.42: 95% CI 1.42–4.11, CD4 values ≥350cells-mm3 aHR 0.52; 95% CI 0.28–0.94, adherence to ART aHR 0.12; 95% CI 0.08–0.20, primary levels of education aHR 2.20; 95% CI 1.07–4.52; and alcohol consumption aHR 1.71; 95% CI 1.04–2.81 were factors strongly associated with mortality.

Conclusion

We found that PLHIV treated by the IPT plus ART had a lower likelihood of mortality and delayed time-to-death when compared to patients treated by ART alone.



Autor: Dumessa Edessa , Jimma Likisa

Fuente: http://plos.srce.hr/



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