Predictors of mortality among individuals with tuberculosis and human immunodeficiency virus coinfection at a reference center in southeastern Brazil: A retrospective cohort study

Abstract

Background: Tuberculosis (TB) remains an important cause of morbidity, the leading cause of death in patients with human immunodeficiency virus (HIV) infection, and a challenge to global public health. This study aimed to analyze the predictors associated with mortality among individuals coinfected with TB/HIV at a reference center in southeastern Brazil. Method: This retrospective cohort study used the data obtained from clinical records and information systems from 2007 to 2014. The data were analyzed using Cox proportional hazards model to identify the independent predictors. Results: Among the 924 individuals studied, 72.7 % were men. The median age was 38 years (range: 16-78 years). The mortality rate was 21.6%. The predictors associated with mortality were as follows: age over 50 years (Adjusted Hazard Ratio [AHR]: 2.52, 95% confidence interval [CI]: 1.39-4.59), CD4+ T lymphocyte count ≤200 cells/mm3 [AHR]: 1.40, 95% [CI]: 0.86-2.27), detectable viral load [AHR]: 1.73, 95% [CI]: 0.98-3.01), and non-use of antiretroviral therapy [AHR]: 2.91, 95% [CI]: 1.71-4.93). Conclusion: Results demonstrated that patients coinfected with TB/HIV have high mortality rates. Therefore, it is necessary to address the social determinants of health to provide every individual an equal opportunity to gain access to healthcare to cope with TB/HIV coinfection.