Factors associated with adverse treatment outcomes of Tuberculosis among HIV-positive adults in an antiretroviral treatment program in Yangon, Myanmar

Abstract: Introduction: Tuberculosis (TB) is the most common opportunistic infection (OI) and cause of death in people living with HIV/AIDS (PLHIV), even in settings with access to antiretroviral therapy (ART). This study aims to determine factors associated with adverse outcome of TB treatment in PLHIV. Materials and Method: The study was retrospective cohort study which includes 958 individuals aged ≥15 years who were registered in a large ART program with comprehensive care for HIV in Yangon. The study period was between January 2012 to December 2014. All individuals who were diagnosed with both HIV and TB were included in the study. Patients’ characteristics, TB history, ART status, CD4 cell count and sputum smear microscopy result were extracted from the clinic database and patient’s medical journals to determine the association with TB treatment outcomes. Data analysis was done by univariate and multivariate logistic regression. Result: Median age of patients was 34 years and 61.5% were male patients. Of 958 patients,654(68.3%) of participants had favorable treatment outcomes, whereas 186(19.4%) died, 88(9.2%) loss to follow up and 30(3.1%) treatment failure during 12 months of study period. The ART coverage was 80% in all TB-HIV co-infected patients. The adverse outcomes were mostly seen in the group of patients who did not receive ART and who did not get tested for CD4 cell counts. Patients who did not receive antiretroviral therapy during the course of antituberculosis treatment and low CD4 cell count at the diagnosis of TB were statistically significant predictors (P value .000) for adverse treatment outcomes of TB. No difference in adverse outcome was seen in patients who had ART in 8 weeks of ATT and after 8 weeks of ATT. Conclusion: Early diagnosis of both infections and early ART initiation during the course of ATT are important factors in preventing adverse outcome of Tuberculosis.