Mortality and associated factors among patients with TB-HIV co-infection in Ethiopia: a systematic review and meta-analysis

Abstract

Abstract Background Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection is a major public health problem in Ethiopia. Patients with TB-HIV co-infection have significantly higher mortality rates compared to those with TB or HIV mono-infection. This systematic review and meta-analysis aim to summarize the evidence on mortality and associated factors among patients with TB-HIV co-infection in Ethiopia. Methods Comprehensive searches were conducted in multiple electronic databases (PubMed/MEDLINE, Embase, CINAHL, Web of Science) for observational studies published between January 2000 and present, reporting mortality rates among TB/HIV co-infected individuals. Two reviewers performed study selection, data extraction, and quality assessment independently. Random-effects meta-analysis was used to pool mortality estimates, and heterogeneity was assessed using I² statistics. Subgroup analyses and meta-regression were performed to explore potential sources of heterogeneity. Results 185 articles were retrieved with 20 studies included in the final analysis involving 8,113 participants. The pooled mortality prevalence was 16.65% (95% CI 12.57%-19.65%) with I2 : 95.98% & p-value < 0.00. Factors significantly associated with increased mortality included: older age above 44 years (HR: 1.82; 95% CI: 1.31–2.52), ambulatory(HR: 1.64; 95% CI: 1.23–2.18) and bedridden functional status(HR: 2.75; 95% CI: 2.01–3.75), extra-pulmonary Tuberculosis (ETB) (HR: 2.34; 95% CI: 1.76–3.10), advanced WHO stage III (HR: 1.76; 95% CI: 1.22–2.38) and WHO stage IV (HR: 2.17; 95% CI:1.41–3.34), opportunistic infections (HR: 1.75; 95% CI: 1.30–2.34), low CD4 count of < 50 cells/mm3 (HR: 3.37; 95% CI: 2.18–5.22) and lack of co-trimoxazole prophylaxis (HR: 2.15; 95% CI: 1.73–2.65). Conclusions TB/HIV co-infected patients in Ethiopia experience unacceptably high mortality, driven by clinical markers of advanced immunosuppression. Early screening, timely treatment initiation, optimizing preventive therapies, and comprehensive management of comorbidities are imperative to improve outcomes in this vulnerable population.