Severity of Outcomes Associated to Types of HIV Coinfection with TB and Malaria in a Setting Where the Three Pandemics Overlap

The objectives of this study is to (1) characterize profiles of HIV coinfection with TB and malaria; (2) estimate the severity of outcome associated with each type of coinfection; (3) identify most severe coinfection type, and populations most affected. Data on 1,302 HIV/AIDS patients were collected from hospital record books for 2007 and 2008. Distribution patterns of types of HIV coinfection with TB and malaria were assessed among low and high SES (socioeconomic status) inpatients. Case fatality rate for each type of coinfection was estimated as the ratio of number of deaths associated with a specific type of coinfection over the number of cases, times 100. Case fatality rates were compared among coinfection types and between low and high SES inpatients. Four types of coinfections were identified: single-HIV, HIV-TB, HIV-malaria and HIV-TB-malaria. Single-HIV infection was the most prevalent, and predominant among high SES inpatients; HIV-TB was the second most prevalent, and predominant among low SES inpatients; HIV-malaria and HIV-TB-malaria coinfections were the least prevalent, they were relatively comparable between both SES groups. HIV-TB coinfection was the deadliest type of coinfection, followed by HIV-TB-malaria and HIV-malaria. Single-HIV infection was the least deadly of the four conditions. Aside from HIV-malaria, the proportion of fatalities associated with each coinfection type was higher among low SES inpatients when compared with high SES inpatients. HIV/AIDS treatment and care programs in communities with limited resources and high prevalence of malaria and TB should give priority attention to low socioeconomic status patients coinfected with TB to prevent unnecessary deaths among those living with HIV.