Survival and risk factors for mortality among HIV/Tuberculosis co-infected patients on antiretroviral therapy in a resource limited setting

Background: Tuberculosis is the most common opportunistic infection and most frequent cause of mortality among HIV-infected persons in resource constrained settings and the number of patients with co-infection continues to grow rapidly. Objective: To determine the survival and predictors of mortality among HIV/Tuberculosis co-infected patients on antiretroviral therapy at Wilkins Infectious Disease Hospital (WIDH), Harare. Methods: A retrospective study in a cohort of 207 HIV/TB co-infected patients who presented to WIDH and started ART between 1 December 2004 and 1 March 2010 was carried out. A retrospective review of patient medical records was done. Kaplan-Meier method was used to construct survival functions, the log rank test was used to test equality of survivor functions across strata; we performed univariate and multivariate analysis and constructed a Cox-proportional hazards model to determine factors that determine survival in HIV/TB co-infected patients on ART. Results: There were 45 (21.7%) deaths at the end of the study among whom 18 (40%) died in those who had extra-pulmonary tuberculosis and 27 (60%) in patients with pulmonary tuberculosis. The mortality rate was 9.8 deaths/100person years of follow-up. The cumulative mortality at 3, 6 and 12 months was 1%, 5% and15% respectively. Independent predictors of mortality were CD4 count