Survival rate and mortality risk factors among TB-HIV co-infected patients at a HIV-specialist hospital in Myanmar: A 12-year retrospective follow-up study

Abstract Background Myanmar is listed as one of the countries with the highest burden of tuberculosis-human immunodeficiency virus infections (TB-HIV) in the world. However, the country’s survival rate and mortality risk factors among TB-HIV co-infected patients remain unstudied. Therefore, the purpose of this study was to examine these factors. Methods A 12-year retrospective follow-up study was conducted among 3598 TB-HIV co-infected patients (2452 male and 1146 female) aged 15 years and above, enrolled on anti-retroviral therapy (ART) from July 1, 2005 to December 31, 2016. Hazard ratios (HR) were estimated using the Cox proportional hazards model. Survival rates at the beginning of ART were calculated using the Kaplan-Meier method. Findings A total of 494 (13·7%) patients died during this period. The survival rates of TB-HIV co-infected patients were 82·0% and 58·1% at 5 and 10 years, respectively. The mortality risk factors were being bedridden (adjusted hazard ratio [aHR], = 2·70, 95% CI: 2·13–3·42], with low baseline CD4 counts (aHR = 1·53, 95% CI: 1·25–1·87), and on the second-line ART regimen (aHR = 8·12, 95% CI: 3·56–18·54). Interpretation Two out of five TB-HIV patients died within 10 years after ART initiation. Current HIV prevention and treatment programs should focus more on bedridden, second-line ART, and low baseline CD4 counts patients.