Clinico-radiological characteristics and lethality of HIV-tuberculosis coinfection in the Infectiology ward of the Libreville University Hospital, Gabon

Résumé

Background: HIV advance disease and tuberculosis (TB) are still frequent in Gabon. Objectives: This study described the clinical and radiological features of bacteriologically confirmed TB among hospitalised persons living with HIV (PLHIV) and in-hospital death-associated factors. Methods: Patients older than 18 years old, with a diagnosis of TB between 2021 and 2022, were prospectively included. Sociodemographic, clinical, radiological data, CD4 cell count, ART, lenght of hospital stay and mortality were recorded and analyzed. Factors associated with patient death were investigated. Results: Overall, 94 (54.7%) of 172 hospitalised PLHIV had TB. Their median age was 37 (32–42) years, 67.0% were females, 47.9% were on ART and 85.0% were in the advanced disease stage. Overall, 52 (55.3%) PLHIV had isolated pulmonary TB, 13 (13.8%) had extra-pulmonary forms, mainly neuromeningeal and lymph node forms, 25(26.6%) had a disseminated TB that involved pulmonary lesions and 4 (4.3%) had an extra-pulmonary disseminated TB. The median CD4 count was 83 (54–128) cells/µL. It was lower in the group of deceased participants (p = 0.04). The case fatality rate was 26.0% (n = 24). Mortality associated factors were length of hospital stay below 10 days (odds ratio [OR] = 3.9 [1.06–14.3], p = 0.04) and CD4 < 200 cells/mm3 (p = 0.01). A trend was also observed for males (OR = 2.11 [0.81–5.5], p = 0.062) and age above 45 years (OR = 2.68 [0.92–7.78], p = 0.07). Conclusion: HIV–TB coinfection and extra-pulmonary forms are still frequent in immunocompromised PLHIV. The in-hospital mortality is high, probably because of late diagnosis. Contribution: This study highlights the need of integrated early HIV and TB diagnosis and management in highly endemic settings to improve coinfected patient outcome. Keywords: HIV–tuberculosis; coinfection; mortality; Gabon; CD4 cells; ART.

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