Display Settings:


Send to:

Choose Destination
See comment in PubMed Commons below
Lancet Infect Dis. 2011 Jul;11(7):533-40. doi: 10.1016/S1473-3099(11)70057-3. Epub 2011 Apr 20.

Use of a WHO-recommended algorithm to reduce mortality in seriously ill patients with HIV infection and smear-negative pulmonary tuberculosis in South Africa: an observational cohort study.

Author information

  • 1Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA. tholtz@th.cdc.gov



In 2007, WHO released revised recommendations and an algorithm for the diagnosis and treatment of smear-negative pulmonary tuberculosis in seriously ill people living with HIV/AIDS. We aimed to assess the effect of the recommendations on clinical outcome in patients in South Africa.


We enrolled seriously ill patients (aged ≥15 years) with HIV infection and suspected smear-negative pulmonary tuberculosis from three hospitals in KwaZulu-Natal, South Africa. Patients were consecutively enrolled into two cohorts: the first cohort was managed according to standard practice, and the second according to the WHO-recommended algorithm. The primary endpoints were rates of continued stay in hospital at 7 days after admission and survival at 8 weeks after admission.


338 patients were enrolled in the standard practice cohort between August, 2008, and February, 2009, and 187 were enrolled in the algorithm cohort between March, 2009, and December, 2009. 7 days after hospital admission, 27% (n=50) of patients in the algorithm cohort were still in hospital, compared with 38% (n=130) in the standard practice cohort (rate ratio 0·70, 95% CI 0·53-0·91; p=0·009). 8 weeks after admission, 83% (n=156) of patients in the algorithm cohort were alive, compared with 68% (n=230) in the standard practice cohort (1·23, 1·11-1·35; p=0·0001), with effect modified by hospital location.


In seriously ill patients with HIV infection and suspected smear-negative pulmonary tuberculosis, early antituberculosis treatment according to the WHO algorithm could significantly reduce mortality in South Africa.


US President's Emergency Plan for AIDS Relief.

Copyright © 2011 Elsevier Ltd. All rights reserved.

Comment in

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk