Diabetes mellitus and tuberculosis treatment outcomes: Assessments of interactions between hyperglycemia and human immunodeficiency virus in the state of Georgia, 2015-2020 Open Access

Houck, Kennedy (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/0c483k86w?locale=en
Published

Abstract

Background: Separately diabetes mellitus (DM) and human immunodeficiency virus (HIV) are risk factors for poor outcomes among people with tuberculosis (TB). To date, information on the joint impact of diabetes and HIV on TB outcomes is limited. We aimed to (1) estimate the association between hyperglycemia with all-cause mortality and sputum culture conversion, and (2) estimate the effect of joint exposure to diabetes and HIV on TB outcomes.

Methods: We conducted a retrospective cohort study among patients with TB in Georgia between 2015-2020. Laboratory and state surveillance records were used to classify patients by diabetes and HIV status. Patients were followed during TB treatment to compare mortality and culture conversion by diabetes and HIV status. Robust Poisson regression was used to estimate risk ratios for all-cause mortality. Cox regression was used to estimate hazard ratios for time to culture conversion. Interaction between DM and HIV was assessed on the additive scale with risk differences and on the multiplicative scale with product terms in regression models.

Results: Of 1109 patients included in the analysis, 318 (28.7%) had diabetes, 92 (8.3%) were HIV-positive, and 15 (1.4%) had diabetes and HIV. Overall, 9.8% died during treatment. Diabetes was associated with an increased risk of death among patients with TB (aRR = 2.59, 95% CI: 1.62, 4.13). The hazard rate of conversion was similar among patients with and without diabetes (aHR = 1.07, 95% CI: 0.86, 1.33). We observed a non-significant trend toward biologic interaction between DM and HIV with all-cause mortality (AP = 23.30%, 95% CI: -48.40%, 95.00%), but did not observe interaction on the multiplicative scale (HIV-positive aRR = 3.03, HIV-negative aRR = 2.81, p = 0.54).

 

Conclusions: More than one-quarter of patients with TB in Georgia had diabetes at time of TB diagnosis. Diabetes alone and co-occurring diabetes and HIV were associated with an increased risk of mortality during TB treatment. These data suggest a potential synergistic effect between diabetes and HIV with increased risk of all-cause mortality during TB treatment.

Table of Contents

List of Tables……………………………………………………………………………………....i

List of Figures………………………………………………………………………………...…...ii

CHAPTER I…………………………………………………………………………………….....1

INTRODUCTION………………………………………………………………………………...1

1.    Background…………………………………………………………………...…………...1

2.    Gaps and Purpose of Study………………………………………………………………..5

CHAPTER II…………………………………………………………………………….………...6

MANUSCRIPT…………………………………………………………………………….……...6

Introduction…………………………………………………………………………………...…...6

Methods…..…………………………………………………………………………………...…...7

Results………………………………………………………………………………………........11

Discussion…………………………………………………………………………………..........16

Conclusion………………………………………………………………………………….........19

THESIS REFERENCES………………………………………………………………….....…...36

APPENDICES…………………………………………………………………………...………43

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