{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T07:35:17Z","timestamp":1769758517579,"version":"3.49.0"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T00:00:00Z","timestamp":1619481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"World Health Organization Country Office in Uzbekistan","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"German KfW Development Bank","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical challenge. People living with HIV have a higher chance of developing TB, and once the disease has progressed, are at greater risk of having unfavorable TB treatment outcomes. Data on TB treatment outcomes among the HIV-associated TB population in Uzbekistan are limited. Thus, we conducted a cohort study among 808 adult patients with HIV-associated TB registered at the Tashkent TB referral hospital from 2013\u20132017 to document baseline characteristics and evaluate risk factors for unfavorable TB treatment outcomes. The data were collected from medical records and ambulatory cards. About 79.8% of the study population had favorable treatment outcomes. Antiretroviral therapy (ART) coverage at the admission was 26.9%. Information on CD4-cell counts and viral loads were largely missing. Having extrapulmonary TB (aOR 2.21, 95% CI: 1.38\u20133.53, p = 0.001), positive sputum smear laboratory results on admission (aOR 1.62, 95% CI: 1.07\u20132.40), diabetes (aOR 5.16, 95% CI: 1.77\u201314.98), and hepatitis C (aOR 1.68, 95% CI: 1.14\u20132.46) were independent risk factors for developing unfavorable TB treatment outcomes. The study findings provide evidence for targeted clinical management in co-infected patients with risk factors. Strengthening the integration of TB\/HIV services may improve availability of key data to improve co-infection management.<\/jats:p>","DOI":"10.3390\/ijerph18094623","type":"journal-article","created":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T06:19:11Z","timestamp":1619504351000},"page":"4623","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Risk Factors for Unfavorable Treatment Outcomes among the Human Immunodeficiency Virus-Associated Tuberculosis Population in Tashkent City, Uzbekistan: 2013\u20132017"],"prefix":"10.3390","volume":"18","author":[{"given":"Sherali","family":"Massavirov","sequence":"first","affiliation":[{"name":"Department of Phthisiology and Pulmonology of the Tashkent Medical Academy, Tashkent 100109, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0177-1870","authenticated-orcid":false,"given":"Kristina","family":"Akopyan","sequence":"additional","affiliation":[{"name":"WHO Regional Office for Europe, DK-2100 Copenhagen, Denmark"},{"name":"Tuberculosis Research and Prevention Center NGO, Yerevan 0070, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fazlkhan","family":"Abdugapparov","sequence":"additional","affiliation":[{"name":"Department of Phthisiology and Pulmonology of the Tashkent Medical Academy, Tashkent 100109, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3260-0348","authenticated-orcid":false,"given":"Ana","family":"Ciobanu","sequence":"additional","affiliation":[{"name":"WHO Regional Office for Europe, DK-2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7904-9071","authenticated-orcid":false,"given":"Arax","family":"Hovhanessyan","sequence":"additional","affiliation":[{"name":"WHO Regional Office for Europe, DK-2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mavluda","family":"Khodjaeva","sequence":"additional","affiliation":[{"name":"Department of Phthisiology and Pulmonology of the Tashkent Medical Academy, Tashkent 100109, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3998-5786","authenticated-orcid":false,"given":"Jamshid","family":"Gadoev","sequence":"additional","affiliation":[{"name":"World Health Organization Country Office in Uzbekistan, 16, Tarobiy Street, Tashkent 100100, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nargiza","family":"Parpieva","sequence":"additional","affiliation":[{"name":"Department of Phthisiology and Pulmonology of the Tashkent Medical Academy, Tashkent 100109, Uzbekistan"},{"name":"The Republican Specialized Scientific-Practical Medical Center of Phthisiology and Pulmonology, Tashkent 100086, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"a017871","DOI":"10.1101\/cshperspect.a017871","article-title":"Tuberculosis and HIV Coinfection","volume":"5","author":"Bruchfeld","year":"2015","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_2","unstructured":"WHO (2020). Global Tuberculosis Report 2020, WHO."},{"key":"ref_3","unstructured":"WHO (2015). Systematic Screening for Active Tuberculosis: An Operational Guide, WHO."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S201","DOI":"10.1086\/651492","article-title":"HIV Infection\u2013Associated Tuberculosis: The Epidemiology and the Response","volume":"50","author":"Getahun","year":"2010","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/S0140-6736(03)14333-4","article-title":"Tuberculosis","volume":"362","author":"Frieden","year":"2003","journal-title":"Lancet"},{"key":"ref_6","unstructured":"(2020, December 12). HIV-Associated Tuberculosis. Available online: https:\/\/www.who.int\/tb\/areas-of-work\/tb-hiv\/tbhiv_factsheet.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1056\/NEJM198903023200901","article-title":"A Prospective Study of the Risk of Tuberculosis among Intravenous Drug Users with Human Immunodeficiency Virus Infection","volume":"320","author":"Selwyn","year":"1989","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1086\/426827","article-title":"How soon after infection with HIV does the risk of tuberculosis start to increase? A retrospective cohort study in South African gold miners","volume":"191","author":"Sonnenberg","year":"2005","journal-title":"J. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1128\/IAI.01126-10","article-title":"HIV-1\/Mycobacterium tuberculosis coinfection immunology: How does HIV-1 exacerbate tuberculosis?","volume":"79","author":"Diedrich","year":"2011","journal-title":"Infect. Immun."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/2049-632X.12108","article-title":"HIV-Mycobacterium tuberculosis co-infection: A \u201cdanger-couple model\u201d of disease pathogenesis","volume":"70","author":"Shankar","year":"2014","journal-title":"Pathog. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Tola, A., Mishore, K.M., Ayele, Y., Mekuria, A.N., and Legese, N. (2019). Treatment Outcome of Tuberculosis and Associated Factors among TB-HIV Co-Infected Patients at Public Hospitals of Harar Town, Eastern Ethiopia. A five-year retrospective study. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7980-x"},{"key":"ref_12","first-page":"154","article-title":"Clinical profile & predictors of poor outcome of adult HIV-tuberculosis patients in a tertiary care centre in north india","volume":"139","author":"Sharma","year":"2014","journal-title":"Indian J. Med. Res."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Sinshaw, Y., Alemu, S., Fekadu, A., and Gizachew, M. (2017). Successful TB treatment outcome and its associated factors among TB\/HIV co-infected patients attending Gondar University Referral Hospital, Northwest Ethiopia: An institution based cross-sectional study. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2238-7"},{"key":"ref_14","unstructured":"WHO (2018). National Clinical Guideline of TB and HIV Coinfection, Uzbekistan, 2018, WHO."},{"key":"ref_15","unstructured":"WHO (2016). Expansion and Optimization of ART in Uzbekistan, WHO."},{"key":"ref_16","unstructured":"WHO (2017). TB Country Profile, Uzbekistan, WHO."},{"key":"ref_17","unstructured":"WHO (2019). Epidemiological Review of Tuberculosis Surveillance in Uzbekistan, WHO."},{"key":"ref_18","unstructured":"(2019, October 03). Uzbekistan|UNAIDS. Available online: https:\/\/www.unaids.org\/en\/regionscountries\/countries\/uzbekistan."},{"key":"ref_19","unstructured":"WHO (2014). National Progress Report on Commitment to Combat HIV\/AIDS, WHO."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S485","DOI":"10.1093\/ofid\/ofz360.1206","article-title":"1342. Impact of HIV Infection on Treatment Outcome of New Tuberculosis Patients Attending Tuberculosis and Antiretroviral Treatment Services in the Community-Based Hospital, Thailand: A Retrospective Cohort Study","volume":"6","author":"Pinsai","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Arpagaus, A., Franzeck, F.C., Sikalengo, G., Ndege, R., Mnzava, D., Rohacek, M., Hella, J., Reither, K., Battegay, M., and Glass, T.R. (2020). Extrapulmonary tuberculosis in HIV-infected patients in rural Tanzania: The prospective Kilombero and Ulanga antiretroviral cohort. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0229875"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.ijid.2008.11.013","article-title":"HIV-associated extrapulmonary tuberculosis in Thailand: Epidemiology and risk factors for death","volume":"13","author":"Kingkaew","year":"2009","journal-title":"Int. J. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1164\/ajrccm\/136.3.570","article-title":"Tuberculosis in Patients with the Acquired Immunodeficiency Syndrome: Clinical Features, Response to Therapy, and Survival","volume":"136","author":"Chaisson","year":"1987","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1556\/1886.2017.00003","article-title":"Epidemiological characteristics and clinical outcome of HIV-related tuberculosis in a population of TB patients in South-Western Nigeria","volume":"7","author":"Olowe","year":"2017","journal-title":"Eur. J. Microbiol. Immunol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1053\/S0882-0546(03)00072-0","article-title":"Clinical and Radiographic Features of HIV-Related Tuberculosis","volume":"18","author":"Burman","year":"2003","journal-title":"Semin. Respir. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s00038-019-01277-2","article-title":"Diabetes mellitus and treatment outcomes of pulmonary tuberculosis: A cohort study","volume":"65","author":"Sahakyan","year":"2020","journal-title":"Int. J. Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1136\/thoraxjnl-2012-201756","article-title":"Association of diabetes and tuberculosis: Impact on treatment and post-treatment outcomes","volume":"68","year":"2013","journal-title":"Thorax"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Viswanathan, V., Kumpatla, S., Aravindalochanan, V., Rajan, R., Chinnasamy, C., Srinivasan, R., Selvam, J.M., and Kapur, A. (2012). Prevalence of diabetes and pre-diabetes and associated risk factors among tuberculosis patients in India. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0041367"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Alebel, A., Wondemagegn, A.T., Tesema, C., Kibret, G.D., Wagnew, F., Petrucka, P., Arora, A., Ayele, A.D., Alemayehu, M., and Eshetie, S. (2019). Prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa: A systematic review and meta-analysis of observational studies. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-3892-8"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3201\/eid1502.080942","article-title":"Causes of death in HIV-infected persons who have tuberculosis, Thailand","volume":"15","author":"Cain","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Sirinak, C., Kittikraisak, W., Pinjeesekikul, D., Charusuntonsri, P., Luanloed, P., Srisuwanvilai, L.O., Nateniyom, S., Akksilp, S., Likanonsakul, S., and Sattayawuthipong, W. (2008). Viral hepatitis and HIV-associated tuberculosis: Risk factors and TB treatment outcomes in Thailand. BMC Public Health, 8.","DOI":"10.1186\/1471-2458-8-245"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/9\/4623\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:53:13Z","timestamp":1760161993000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/9\/4623"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,27]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["ijerph18094623"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18094623","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,27]]}}}