Increased risk of all-cause mortality in co-occurring diabetes, HIV during TB treatment

All-cause mortality risk was found to be increased among patients with with co-occurring diabetes and HIV infection receiving treatment for tuberculosis (TB) infection, according to study findings published in Open Forum Infectious Diseases.

While diabetes and HIV have been identified as independent risk factors for poor clinical outcomes in patients with TB, there is limited data on the joint impact of these risk factors in TB. Researchers conducted a retrospective cohort study to assess the association between hyperglycemia and mortality and the exposure to both diabetes and HIV on mortality. 

A total of 1703 TB case reports from the Georgia Department of Health’s State Electronic Notifiable Disease Surveillance System (SendSS) were collected and assessed. Of those cases, 1109 met eligibility criteria and were included in the study.  Patients were excluded if diabetes, blood glucose, and HbA1c data were missing from the medical record. The patients were aged a median of 48.0 years (interquartile range [IQR], 28.0) and 66.6% were male, 45.3% were non-Hispanic Black, and 51.6% were born outside of the US.

The primary outcome was all-cause mortality before and during TB treatment. Death during treatment was defined as death before treatment completion or within 7 days of treatment completion. The patients’ diabetes status was categorized into 3 categories: no diabetes, pre-diabetes, or diabetes.

Of the 1109 patients, 318 (28.7%) had diabetes, 149 (13.4%) were classified as having pre-diabetes, and 642 (57.9%) did not have diabetes. The researchers reported 92 (8.3%) were HIV-positive, 970 (87.5%) were HIV-negative, and 47 (4.2%) had an unknown HIV status. There were 15 patients (1.4%) with both HIV and diabetes and 11 (1.0%) patients with HIV and prediabetes. The researchers found risk of mortality was highest among patients with diabetes and HIV coinfection.

A total of 109 (9.8%) patients reportedly died before or during TB treatment, 56 (17.6%) with diabetes, 17 (11.4%) with pre-diabetes, and 36 (5.6%) with no diabetes (P =.04). 

The researchers noted an association between diabetes and an increased risk of death in patients with TB (adjusted risk ratio [aRR], 2.59; 95% CI, 1.62-4.13). Risk of death was not significant among patients with pre-diabetes and TB (aRR, 1.89; 95% CI, 0.99-3.61).

Study limitations include the limited laboratory values to assess diabetes status, inability to distinguish between stress hyperglycemia and diabetes, and lack of access to data on diabetes duration. 

“Diabetes co-occurrence is common among people with TB in Georgia, and mortality among these individuals is high,” the researchers concluded. “These results highlight the need for regular screening of people with TB for diabetes and HIV, and careful monitoring of individuals with comorbidities.”

References:

Houck K, Chakhaia T, Gorvetzian S, Critchley JA, Schechter MC, Magee MJ. Diabetes mellitus and tuberculosis treatment outcomes: Interaction assessment between hyperglycemia and human immunodeficiency virus in the state of Georgia, 2015-2020. Open Forum Infect Dis. Published online May 10, 2023. doi:10.1093/ofid/ofad255

Source: Endocrinology Advisor Update