Table 3.
Predictors and Hazard Ratios for Relapse Among Visceral Leishmaniasis and HIV Coinfected Patients Treated by Médecins Sans Frontières in Ethiopia From February 2008 to December 2013 (N = 146)
| Predictors | n/N (%) | Crude HR (95% CI) | P | Adjusted HR (95% CI) | P |
|---|---|---|---|---|---|
| Age (years) | |||||
| >40 | 9/23 (39.1) | 1.00 | |||
| 30–40 | 18/64 (28.1) | 1.45 (0.65–3.26) | .37 | ||
| <30 | 17/59 (28.8) | 1.00 (0.52–1.95) | .99 | ||
| Sex | |||||
| Male | 43/140 (30.7) | 1.00 | |||
| Female | 1/6 (16.7) | 0.48 (0.07–3.52) | .47 | ||
| Previous VL episode | |||||
| No | 35/110 (31.8) | 1.00 | |||
| Yes | 9/36 (25.0) | 0.80 (0.39–1.67) | .56 | ||
| Advanced HIV stage a | |||||
| No | 7/23 (30.4) | 1.00 | |||
| Yes | 36/110 (32.7) | 0.91 (0.40−2.06) | .83 | ||
| Spleen size at admission (cm) | |||||
| 0 | 2/18 (11.1) | 1.00 | |||
| 1–5 | 16/40 (40.0) | 4.12 (0.95–17.99) | .06 | ||
| ≥5 | 25/86 (29.1) | 3.75 (0.89–15.88) | .07 | ||
| Body mass index at admission (kg/m 2) | |||||
| <16 | 18/58 (31.0) | 1.00 | |||
| ≥16 | 20/76 (26.3) | 0.73 (0.39–1.38) | .33 | ||
| Hemoglobin level at admission (g/dL) | |||||
| <7 | 7/33 (21.2) | 1.00 | |||
| 7−10 | 23/74 (31.1) | 1.34 (0.58–3.14) | .49 | ||
| >10 | 13/37 (35.1) | 1.55 (0.62–3.88) | .35 | ||
| Parasite grade at VL diagnosis | |||||
| <6+ | 26/84 (30.9) | 1.0 | 1.00 | ||
| 6+ | 10/22 (45.4) | 3.22 (1.53−6.78) | .002 | 6.63 (2.64−16.63) | <.001 |
| Not done: serological/clinical diagnosisb | 8/40 (20.0) | 0.49 (0.22−1.09) | .08 | 0.49 (0.22−1.09) | .08 |
| Tuberculosis | |||||
| Yes | 10/32 (31.2) | 1.00 | |||
| No | 33/113 (29.2) | 1.00 (0.49–2.03) | .99 | ||
| ART regimen c | |||||
| Non–tenofovir-based | 24/76 (31.6) | 1.00 | |||
| Tenofovir-based | 15/64 (23.4) | 1.01 (0.53–1.94) | .98 | ||
| Timing of ART initiation | |||||
| After VL treatment | 18/41 (43.9) | 1.00 | |||
| During VL treatment | 8/40 (20.0) | 0.47 (0.20−1.07) | .07 | 0.39 (0.17−0.86) | .02 |
| Before VL treatment | 13/57 (22.8) | 0.49 (0.24−1.01) | .05 | 0.22 (0.10−0.52) | <.001 |
| Never initiated | 5/6 (83.3) | 2.04 (0.75−5.55) | .16 | ||
| Initial VL regimen | |||||
| Other (AmBisome or sodium stibogluconate) | 31/87 (35.6) | 1.00 | |||
| AmBisome and Miltefosine | 13/59 (22.0) | 0.85 (0.44–1.63) | .62 | ||
| Spleen size at discharge (cm) | |||||
| 0 | 26/81 (32.1) | 1.00 | |||
| 1–5 | 13/44 (29.6) | 1.06 (0.54–2.06) | .87 | ||
| ≥5 | 2/14 (14.3) | 0.55 (0.13–2.30) | .41 | ||
| Body mass index at discharge (kg/m 2) | |||||
| <16 | 38/118 (32.2) | 1.00 | |||
| ≥16 | 5/27 (18.5) | 0.67 (0.27–1.71) | .41 | ||
| Hemoglobin level at discharge (g/dL) | |||||
| 0 | 1/13 (7.7) | 1.00 | |||
| 7−10 | 27/76 (35.5) | 4.45 (0.60–32.8) | .14 | ||
| >10 | 15/48 (31.2) | 3.49 (0.46–26.5) | .22 | ||
Abbreviations: ART, antiretroviral therapy; CI, confidence interval; HIV, human immunodeficiency virus; VL, visceral leishmaniasis.
aWHO stage IV or CD4 <50 cells/µL.
b37 are primary VL cases and 3 are relapse VL cases.
cStavudine, lamivudine and nevirapine; zidovudine, lamivudine and efavirenz; tenofovir, lamivudine and efavirenz; zidovudine, lamivudine and nevirapine; stavudine, lamivudine and efavirenz.