Mortality and associated factors among patients with TB-HIV co-infection in Ethiopia: a systematic review and meta-analysis.
BMC Infect Dis
; 24(1): 773, 2024 Aug 02.
Article
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| MEDLINE
| ID: mdl-39095740
ABSTRACT
BACKGROUND:
Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection is a major public health problem in Ethiopia. Patients with TB-HIV co-infection have significantly higher mortality rates compared to those with TB or HIV mono-infection. This systematic review and meta-analysis aim to summarize the evidence on mortality and associated factors among patients with TB-HIV co-infection in Ethiopia.METHODS:
Comprehensive searches were conducted in multiple electronic databases (PubMed/MEDLINE, Embase, CINAHL, Web of Science) for observational studies published between January 2000 and present, reporting mortality rates among TB/HIV co-infected individuals. Two reviewers performed study selection, data extraction, and quality assessment independently. Random-effects meta-analysis was used to pool mortality estimates, and heterogeneity was assessed using I² statistics. Subgroup analyses and meta-regression were performed to explore potential sources of heterogeneity.RESULTS:
185 articles were retrieved with 20 studies included in the final analysis involving 8,113 participants. The pooled mortality prevalence was 16.65% (95% CI 12.57%-19.65%) with I2 95.98% & p-value < 0.00. Factors significantly associated with increased mortality included older age above 44 years (HR 1.82; 95% CI 1.31-2.52), ambulatory(HR 1.64; 95% CI 1.23-2.18) and bedridden functional status(HR 2.75; 95% CI 2.01-3.75), extra-pulmonary Tuberculosis (ETB) (HR 2.34; 95% CI 1.76-3.10), advanced WHO stage III (HR 1.76; 95% CI 1.22-2.38) and WHO stage IV (HR 2.17; 95% CI1.41-3.34), opportunistic infections (HR 1.75; 95% CI 1.30-2.34), low CD4 count of < 50 cells/mm3 (HR 3.37; 95% CI 2.18-5.22) and lack of co-trimoxazole prophylaxis (HR 2.15; 95% CI 1.73-2.65).CONCLUSIONS:
TB/HIV co-infected patients in Ethiopia experience unacceptably high mortality, driven by clinical markers of advanced immunosuppression. Early screening, timely treatment initiation, optimizing preventive therapies, and comprehensive management of comorbidities are imperative to improve outcomes in this vulnerable population.Palabras clave
Texto completo:
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Base de datos:
MEDLINE
Asunto principal:
Tuberculosis
/
Infecciones por VIH
/
Coinfección
País/Región como asunto:
Africa
Idioma:
En
Revista:
BMC Infect Dis
Asunto de la revista:
DOENCAS TRANSMISSIVEIS
Año:
2024
Tipo del documento:
Article