Tuberculosis HIV Co-infection: Epidemiological, Clinical, Therapeutic and Evolutionary Profile of Patients Hospitalized in the Befelatanana Infectious Diseases Department

Abstract Introduction Tuberculosis and HIV-AIDS co-infection (TB-HIV) form a deadly pair. Tuberculosis remains the most frequent opportunistic infection in HIV-positive subjects in many developing countries. Our aim is to describe TB-HIV co-infection in Madagascar. Methods This was a retrospective, descriptive cross-sectional study from January, 2020 to December, 2023. Consecutive patients hospitalized with HIV and a diagnosis of active TB were included. Results We identified 122 cases (35.4%) of TB-HIV co-infection out of a total 345 hospitalized patients with HIV; 78.7% were new cases. The mean age was 34.5 yrs (range 18-69), 73% were male, 19.7% were commercial sex workers and 36.9% had multiple sexual partners. Concurrent opportunistic infections were common and included: pneumocystis pneumonia (49.2%), oropharyngeal candidiasis (38.6%), bacterial pneumonia (21.3%), cerebral toxoplasmosis (2.5%) and cryptococcosis (4.9%). CD4 count was < 200 cells/mm³ in 96.3% of patients. Mortality was 21.5%. In multivariate analysis, predictors of mortality were CD4 < 200 cells/mm3(p=0.01), anemia (p=0,001) and the presence of concomitant opportunistic infection (p=0,0045). Conclusion TB-HIVco-infection is a leading cause of hospitalization in patients with HIV in Madagascar and is associated with high mortality. Concurrent opportunistic infection is common. Anemia, CD4 < 200 cells/mm³ and concurrent opportunistic infections are associated with increased risk for mortality.