Risk factors for active Tuberculosis in HIV patients on ART: Esperança Hospital, Luanda, Angola 2018

  • Viral hepatitis and HIV
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Background: In 2017, an estimated 920 000 people living with HIV (PLHIV) have fallen ill with Tuberculosis (TB) worldwide. Angola is one of 20 countries with the highest estimated numbers of incident TB cases among PLHIV. Isoniazid preventive therapy (IPT) national policy for PLHIV was published in 2018 but with slow implementation. The objective of this study was to assess the incidence and risk factors for active TB among PLHIV on antiretroviral therapy (ART) in a tertiary HIV specialized hospital in Luanda, Angola.
Methods: The sample size of 813 patients was calculated using an estimated prevalence of 10%, 95%CI and 1% precision. A cross-sectional study was conducted at Hospital Esperança between January-December 2018. Cases were defined as PLHIV who developed active TB while on ART. Semi-structured questionnaires and review of clinical files were used for data collection. Significance level was set at p<0.05 for all hypothesis tests. Pearson chi-squared (χ2) tests, followed by multivariable logistic regression modelling were used to identify factors associated with active TB.
Results: A total of 849 HIV positive study participants were enrolled. Of these, 111(13.1%) were found to have active pulmonary tuberculosis. Independent risk factors for TB were: contact with active TB cases Adjusted OR = 341.40; 95% CI: 60.8 - 1918.6; p<0.01; active tobacco smoking Adjusted OR = 8.1; 95% CI: 1.4-46.1; p<0.01; having a CD4 count below 200 cells/mm3 Adjusted OR = 126.1; 95% CI: 2.9 - 5404.4; p<0.01; immune failure Adjusted OR = 4.1; 95% CI: 1.11-15.1; p<0.05.
Conclusions: Our study is the first in Angola to provide insightful data on active TB infection among PLHIV on ART. The alarmingly high incidence of active TB among PLHIV found in our study clearly shows the urgent need for stringent IPT policy implementation and increased coverage among PLHIV with a negative TB screening.

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