title: Early Mortality during Initial Treatment of Tuberculosis in Patients Co-Infected with HIV at the Yaoundé Central Hospital, Cameroon: An 8-Year Retrospective Cohort Study (2006-2013).
abstract: BACKGROUND
  Understanding contributors to mortality during the initial phase of tuberculosis (TB) treatment in patients co-infected with HIV would guide targeted interventions to improve survival. The aim of this study was to ascertain the incidence of death during the initial 2 months (new cases) and 3 months (retreatment cases) of TB treatment and to assess correlates of mortality in HIV co-infected patients.
  
  
  METHODS
  We conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify co-infected TB/HIV inpatients aged 15 years and older who died during TB treatment. Death was defined as any death occurring during TB treatment, as per World Health Organization recommendations. We collected socio-demographic, clinical and laboratory data. We conducted multivariable logistic binary regression analysis to identify factors associated with death during the intensive phase of TB treatment. Magnitudes of associations were expressed by adjusted odds ratio (aOR) with 95% confidence interval. A p value < 0.05 was considered statistically significant.
  
  
  RESULTS
  The 99 patients enrolled had a mean age of 39.5 (standard deviation 10.9) years and 53% were male. Patients were followed for 276.3 person-months of observation (PMO). Forty nine patients were died during intensive phase of TB treatment. Death incidence during the intensive phase of TB treatment was 32.2 per 100 PMO. Having a non-AIDS comorbidity (aOR 2.47, 95%CI 1.22-5.02, p = 0.012), having extra-pulmonary TB (aOR 1.89, 95%CI 1.05-3.43, p = 0.035), and one year increase in duration of known HIV infection (aOR 1.23, 95%CI 1.004-1.49) were independently associated with death during the intensive phase of TB treatment.
  
  
  CONCLUSIONS
  Mortality incidence during intensive phase of TB treatment was high among TB/HIV co-infected patients during TB treatment; and strongly associated with extra pulmonary TB suggesting advanced stage of immunosuppression and non-AIDS comorbidities. Early HIV diagnosis and care and good management of non-comorbidities can reduce this incidence.
authors.affiliation: Department of Epidemiology and Public Health, Pasteur Center of Cameroon, Yaoundé, Cameroon.
authors.forename: Jean Joel R
authors.initials: JJ
authors.lastname: Bigna
authors.affiliation: Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; Medical Diagnosis Center, Yaoundé, Cameroon.
authors.forename: Jean Jacques N
authors.initials: JJ
authors.lastname: Noubiap
authors.affiliation: Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
authors.forename: Ako A
authors.initials: AA
authors.lastname: Agbor
authors.affiliation: Department of Medicine, NYU-Langone Medical Center, New York, New York, United States of America.
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Plottel
authors.affiliation: Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; National AIDS control committee, Ministry of Public Health, Yaoundé, Cameroon.
authors.forename: Serge Clotaire
authors.initials: SC
authors.lastname: Billong
authors.affiliation: Faculty of Medicine and Pharmaceutic Sciences, University of Douala, Douala, Cameroon.
authors.forename: André Patrick R
authors.initials: AP
authors.lastname: Ayong
authors.affiliation: Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; Infectious Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon.
authors.forename: Sinata
authors.initials: S
authors.lastname: Koulla-Shiro
mesh_terms: D000328:Adult; D002163:Cameroon / Q000453:epidemiology; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality