title: Factors associated with death during tuberculosis treatment of patients co-infected with HIV at the Yaoundé Central Hospital, Cameroon: an 8-year hospital-based retrospective cohort study (2006-2013).
abstract: BACKGROUND
  Contributors to fatal outcomes in TB/HIV co-infected patients actively undergoing TB treatment are poorly characterized. The aim was to assess factors associated with death in TB/HIV co-infected patients during the initial 6 months of TB treatment.
  
  
  METHODS
  We conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at the Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify hospitalized co-infected TB/HIV patients aged 15 years and older. Death was defined as any death occurring during TB treatment, as per the World Health Organization's recommendations. We conducted logistic regression analysis to identify factors associated with a fatal outcome. Magnitudes of associations were expressed by adjusted odds ratio (aOR) with 95% confidence interval.
  
  
  RESULTS
  The 337 patients enrolled had a mean age of 39.3 (standard deviation 10.3) years and 54.3% were female. TB treatment outcomes were distributed as follows: 205 (60.8%) treatment success, 99 (29.4%) deaths, 18 (5.3%) not evaluated, 14 (4.2%) lost to follow-up, and 1 (0.3%) failed. After exclusion of patients lost to follow-up and not evaluated, death in TB/HIV co-infected patients during TB treatment was associated with a TB diagnosis made before 2010 (aOR = 2.50 [1.31-4.78]; p = 0.006), the presence of other AIDS-defining diseases (aOR = 2.73 [1.27-5.86]; p = 0.010), non-AIDS comorbidities (aOR = 3.35 [1.37-8.21]; p = 0.008), not receiving cotrimoxazole prophylaxis (aOR = 3.61 [1.71-7.63]; p = 0.001), not receiving antiretroviral therapy (aOR = 2.45 [1.18-5.08]; p = 0.016), and CD4 cells count <50 cells/mm3 (aOR = 16.43 [1.05-258.04]; p = 0.047).
  
  
  CONCLUSIONS
  The TB treatment success rate among TB/HIV co-infected patients in our setting is low. Mortality was high among TB/HIV co-infected patients during TB treatment and is strongly associated with clinical and biological factors, highlighting the urgent need for specific interventions focused on enhancing patient outcomes.
authors.affiliation: Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon.
authors.forename: Ako A
authors.initials: AA
authors.lastname: Agbor
authors.affiliation: Goulfey Health District Unit, Ministry of Public Health, P.O. Box 62 Kousséri, Goulfey, Cameroon.
authors.forename: Jean Joel R
authors.initials: JJ
authors.lastname: Bigna
authors.affiliation: Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon; National AIDS control committee, Ministry of Public Health, P.O. Box 1459, Yaoundé, Cameroon.
authors.forename: Serges Clotaire
authors.initials: SC
authors.lastname: Billong
authors.affiliation: Department of Epidemiology and Public Health, Centre Pasteur of Cameroun, P.O. Box 1264 Yaoundé, Cameroon, Member International Network of the Pasteur Institute.
authors.forename: Mathurin Cyrille
authors.initials: MC
authors.lastname: Tejiokem
authors.affiliation: National AIDS control committee, Ministry of Public Health, P.O. Box 1459, Yaoundé, Cameroon.
authors.forename: Gabriel L
authors.initials: GL
authors.lastname: Ekali
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, New York, United States of America; Department of Medicine, New York University School of Medicine, New York, New York, United States of America.
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Plottel
authors.affiliation: Internal Medicine Unit, Edéa Regional Hospital, P.O. Box 100 Edéa, Cameroon.
authors.forename: Jean Jacques N
authors.initials: JJ
authors.lastname: Noubiap
authors.affiliation: Infectious Diseases Unit, Yaoundé Central Hospital, P.O. Box 5555 Yaoundé, Cameroon.
authors.forename: Hortence
authors.initials: H
authors.lastname: Abessolo
authors.affiliation: Infectious Diseases Unit, Yaoundé Central Hospital, P.O. Box 5555 Yaoundé, Cameroon.
authors.forename: Roselyne
authors.initials: R
authors.lastname: Toby
authors.affiliation: Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon; Infectious Diseases Unit, Yaoundé Central Hospital, P.O. Box 5555 Yaoundé, Cameroon.
authors.forename: Sinata
authors.initials: S
authors.lastname: Koulla-Shiro
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D002163:Cameroon / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D060085:Coinfection / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination