Risk factors associated with 1-year mortality among patients with HIV-associated tuberculosis in areas with intermediate tuberculosis burden and low HIV prevalence.

INTRODUCTION: Data are limited regarding risk factors for mortality among patients with human immunodeficiency virus (HIV)-associated tuberculosis (TB) in areas with low HIV prevalence and intermediate TB burden, such as the Western Pacific region. This study aimed to assess such risk factors in Hong Kong, which has an intermediate TB burden and low HIV prevalence. METHODS: We conducted a retrospective cohort analysis of adult patients reported to the Hong Kong TB-HIV Registry between 2006 and 2015. Baseline characteristics were compared with Kaplan-Meier estimates. Cox proportional hazards regression modelling was used to identify factors associated with mortality. RESULTS: Of 299 patients studied, 21 (7.0%) died within 12 months of anti-TB treatment (median [interquartile range], 7.5 [3.8-10] months). The median age of death was 54 (interquartile range, 40.5-75.0) years. The cause of death was TB in five and unrelated to TB in the remaining 16. Cox proportional hazards regression showed that older age (adjusted hazard ratio=4.5; 95% confidence interval [CI]=1.4-14.9), history of drug addiction (4.6; 95% CI=1.6-13.0), and low baseline CD4 cell count of <50/µL (2.9; 95% CI=1.1-7.7) were independent risk factors for death within 12 months. CONCLUSION: This study complements previous studies by providing information regarding risk factors associated with mortality among patients with HIV-associated TB in areas with intermediate TB burden and low HIV prevalence. The results from our study may guide targeted measures to improve survival in other areas with intermediate TB burden and low HIV prevalence, such as the Western Pacific region.

Management of health care workers following occupational exposure to hepatitis B, hepatitis C, and human immunodeficiency virus.

INTRODUCTION: Needlestick injury or mucosal contact with blood or body fluids is well recognised in the health care setting. This study aimed to describe the post-exposure management and outcome in health care workers following exposure to hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) during needlestick injury or mucosal contact. METHODS: This case series study was conducted in a public clinic in Hong Kong. All health care workers with a needlestick injury or mucosal contact with blood or body fluids who were referred to the Therapeutic Prevention Clinic of Department of Health from 1999 to 2013 were included. RESULTS: A total of 1525 health care workers were referred to the Therapeutic Prevention Clinic following occupational exposure. Most sustained a percutaneous injury (89%), in particular during post-procedure cleaning or tidying up. Gloves were worn in 62.7% of instances. The source patient could be identified in 83.7% of cases, but the infection status was usually unknown, with baseline positivity rates of hepatitis B, hepatitis C, and HIV of all identified sources, as reported by the injured, being 7.4%, 1.6%, and 3.3%, respectively. Post-exposure prophylaxis of HIV was prescribed to 48 health care workers, of whom 14 (38.9%) had been exposed to known HIV-infected blood or body fluids. The majority (89.6%) received HIV post-exposure prophylaxis within 24 hours of exposure. Drug-related adverse events were encountered by 88.6%. The completion rate of post-exposure prophylaxis was 73.1%. After a follow-up period of 6 months (or 1 year for those who had taken HIV post-exposure prophylaxis), no hepatitis B, hepatitis C, or HIV seroconversions were detected. CONCLUSIONS: Percutaneous injury in the health care setting is not uncommon but post-exposure prophylaxis of HIV is infrequently indicated. There was no hepatitis B, hepatitis C, and HIV transmission via sharps or mucosal injury in this cohort of health care workers.