{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T19:39:34Z","timestamp":1776973174828,"version":"3.51.4"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T00:00:00Z","timestamp":1667174400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>In resource-limited countries such as Ethiopia, tuberculosis is the major cause of morbidity and mortality among people living with the human immunodeficiency virus. In the era of antiretroviral therapy, the effect of tuberculosis on the survival of patients who are living with human immunodeficiency virus has been poorly understood in Ethiopia. Therefore, this study aimed to determine the effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy in public hospitals in Eastern Ethiopia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>An institution-based retrospective cohort study was conducted among 566 participants from January 1, 2014, to June 30, 2018. The collected data were entered into EpiData version 3.1 before being exported to Stata version 14 for analysis. A Cox proportional hazard model was used to determine the effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy, and a p-value less than 0.05 and a 95% confidence level were used to declare statistical significance.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Result<\/jats:title>\n<jats:p>Of the 566 patients included in the study, 76 died. The mortality rate was 11.04 per 100 person-years in tuberculosis co-infected patients, while it was 2.52 per 100 person-years in non-tuberculosis co-infected patients. The patients with tuberculosis co-infection had a 2.19 times higher hazard of death (AHR: 2.19; 95% CI: 1.17, 4.12) compared to those without tuberculosis. Advanced clinical stage, low CD4+ cell count, and previous episodes of an opportunistic infection other than tuberculosis were found to be independent predictors of mortality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Co-infection with tuberculosis at antiretroviral therapy initiation increases the hazard of death approximately two-fold. Hence, we recommend key organizations to enhance the region\u2019s collaborative interventional and preventative strategies for TB and HIV.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0277021","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T17:47:02Z","timestamp":1667238422000},"page":"e0277021","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy at public hospitals of Eastern Ethiopia: A retrospective cohort study"],"prefix":"10.1371","volume":"17","author":[{"given":"Tadesse","family":"Sime","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4542-2509","authenticated-orcid":true,"given":"Lemessa","family":"Oljira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aboma","family":"Diriba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gamachis","family":"Firdisa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5503-1360","authenticated-orcid":true,"given":"Wubishet","family":"Gezimu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,10,31]]},"reference":[{"issue":"2","key":"pone.0277021.ref001","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1128\/CMR.00042-10","article-title":"HIV and Tuberculosis: a Deadly Human Syndemic","volume":"24","author":"C.K. Kwan","year":"2011","journal-title":"Clinical Microbiology Reviewes"},{"key":"pone.0277021.ref002","author":"WHO","year":"2015","journal-title":"WHO | Tuberculosis and HIV"},{"key":"pone.0277021.ref003","author":"WHO","year":"2018","journal-title":"WHO | TB comorbidities and risk factors"},{"key":"pone.0277021.ref004","first-page":"566","volume":"70","author":"D. Zenner","year":"2015","journal-title":"Impact of TB on the survival of people living with HIV infection in England, Wales and Northern Ireland Thorax"},{"issue":"1","key":"pone.0277021.ref005","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/1742-6405-10-19","article-title":"Impact of tuberculosis on mortality among HIV-infected patients receiving antiretroviral therapy in Uganda: a prospective cohort analysis","volume":"10","author":"R. Chu","year":"2013","journal-title":"AIDS research and therapy"},{"key":"pone.0277021.ref006","first-page":"2017","author":"WHO","year":"2017","journal-title":"Global tuberculosis report"},{"issue":"5","key":"pone.0277021.ref007","doi-asserted-by":"crossref","first-page":"537","DOI":"10.5588\/ijtld.16.0775","article-title":"Implementing Isoniazid Preventive Therapy in a TB-treatment experienced cohort on ART","volume":"21","author":"Bhavna Maharaj","year":"2017","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0277021.ref008","author":"EPHI","year":"2015","journal-title":"Ethiopian Public Health Institute NATIONAL TB\/HIV Sentinel Surveillance Annual Report"},{"issue":"1","key":"pone.0277021.ref009","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4314\/ejhs.v27i1.4S","article-title":"Factors Associated with Mortality of TB\/HIV Co-infected Patients in Ethiopia","volume":"27","author":"A.M. Teklu","year":"2017","journal-title":"Ethiop J Health Sci"},{"key":"pone.0277021.ref010","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1186\/1471-2334-13-297","article-title":"Predictors of mortality among TB-HIV Co-infected patients being treated for tuberculosis in Northwest Ethiopia: a retrospective cohort study","volume":"13","author":"B. Sileshi","year":"2013","journal-title":"BMC infectious diseases"},{"key":"pone.0277021.ref011","article-title":"Survival and determinants of mortality in adult HIV\/Aids patients initiating antiretroviral therapy in Somali Region, Eastern Ethiopia","author":"B. Damtew","year":"2014","journal-title":"Journal of AIDS & Clinical Research"},{"issue":"14","key":"pone.0277021.ref012","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1097\/QAD.0b013e32830e010c","article-title":"Effect of tuberculosis on the survival of HIV-infected men in a country with low tuberculosis incidence","volume":"22","author":"H. L\u00f3pez-Gatell","year":"2008","journal-title":"AIDS"},{"key":"pone.0277021.ref013","first-page":"63","volume":"27","author":"D. Fekade","year":"2017","journal-title":"Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study"},{"key":"pone.0277021.ref014","first-page":"e2016049","article-title":"Survival and predictors of mortality among human immunodeficiency virus patients on anti-retroviral treatment at Jinka Hospital, South Omo, Ethiopia: a six years retrospective cohort study","volume":"38","author":"E. Tachbele","year":"2016","journal-title":"Epidemiology and health"},{"key":"pone.0277021.ref015","first-page":"2015","article-title":"Predictors of mortality among adult antiretroviral therapy users in southeastern Ethiopia: retrospective cohort study","author":"T. Setegn","year":"2015","journal-title":"AIDS research and treatment"},{"key":"pone.0277021.ref016","author":"WHO","year":"2015","journal-title":"A guide to monitoring and evaluation for collaborative TB\/HIV activities: 2015 revision\/"},{"key":"pone.0277021.ref017","author":"FMOH","year":"2017","journal-title":"Ethiopia National guidelines for comprehensive HIV prevention, care and treatment Federal ministry of health"},{"issue":"12","key":"pone.0277021.ref018","doi-asserted-by":"crossref","first-page":"e15241","DOI":"10.1371\/journal.pone.0015241","article-title":"The Effect of Tuberculosis on Mortality in HIV Positive People: A Meta-Analysis","volume":"5","author":"M. Straetemans","year":"2011","journal-title":"PLOS ONE"},{"key":"pone.0277021.ref019","doi-asserted-by":"crossref","DOI":"10.1002\/9780470258019","author":"D.W. Hosmer","year":"2008","journal-title":"Applied survival analysis: regression modeling of time-to-event data, 2nd Edition"},{"issue":"1","key":"pone.0277021.ref020","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1742-6405-9-15","article-title":"Predictors of mortality among HIV infected patients taking antiretroviral treatment in Ethiopia: a retrospective cohort study","volume":"9","author":"S. Biadgilign","year":"2012","journal-title":"AIDS research and therapy"},{"key":"pone.0277021.ref021","doi-asserted-by":"crossref","first-page":"843598","DOI":"10.1155\/2012\/843598","article-title":"High Initial HIV\/AIDS-Related Mortality and -Its Predictors among Patients on Antiretroviral Therapy in the Kagera Region of Tanzania: A Five-Year Retrospective Cohort Study","volume":"2012","author":"K. Mageda","year":"2012","journal-title":"AIDS research and treatment"},{"issue":"2","key":"pone.0277021.ref022","doi-asserted-by":"crossref","first-page":"e55824","DOI":"10.1371\/journal.pone.0055824","article-title":"Prevalent and Incident Tuberculosis Are Independent Risk Factors for Mortality among Patients Accessing Antiretroviral Therapy in South Africa","volume":"8","author":"A. Gupta","year":"2013","journal-title":"PLOS ONE"},{"issue":"6","key":"pone.0277021.ref023","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1097\/QAD.0b013e328325d115","article-title":"Effect of pulmonary tuberculosis on mortality in patients receiving HAART","volume":"23","author":"D. Westreich","year":"2009","journal-title":"Aids"},{"issue":"4","key":"pone.0277021.ref024","doi-asserted-by":"crossref","first-page":"ofx219","DOI":"10.1093\/ofid\/ofx219","article-title":"Long-term Outcome of Antiretroviral Treatment in Patients With and Without Concomitant Tuberculosis Receiving Health Center-Based Care-Results From a Prospective Cohort Study","volume":"4","author":"A. Reepalu","year":"2017","journal-title":"Open forum infectious diseases"},{"key":"pone.0277021.ref025","article-title":"Survival status of hiv positive adults on antiretroviral treatment in Debre Markos Referral Hospital, Northwest Ethiopia: retrospective cohort study","author":"N. Abebe","year":"2014","journal-title":"The Pan African Medical Journal"},{"key":"pone.0277021.ref026","volume":"2","author":"T. Digaffe","year":"2014","journal-title":"Survival and Predictors of Mortality among Adults on Antiretroviral Therapy in Selected Public Hospitals in Harar, Eastern Ethiopia"},{"issue":"1","key":"pone.0277021.ref027","doi-asserted-by":"crossref","first-page":"e87392","DOI":"10.1371\/journal.pone.0087392","article-title":"Predictors of mortality among patients enrolled on antiretroviral therapy in Aksum hospital, northern Ethiopia: a retrospective cohort study","volume":"9","author":"K. Tadesse","year":"2014","journal-title":"PloS one"},{"issue":"1","key":"pone.0277021.ref028","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1353\/hpu.2013.0014","article-title":"The problem of late ART initiation in Sub-Saharan Africa: a transient aspect of scale-up or a long-term phenomenon?","volume":"24","author":"M. Lahuerta","year":"2013","journal-title":"Journal of health care for the poor and underserved"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0277021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T17:47:30Z","timestamp":1667238450000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0277021"}},"subtitle":[],"editor":[{"given":"Ari","family":"Samaranayaka","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,10,31]]},"references-count":28,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0277021","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,31]]}}}