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Int J Infect Dis. 2017 Mar;56:39-44. doi: 10.1016/j.ijid.2017.01.023. Epub 2017 Feb 1.

Tuberculosis associated mortality in a prospective cohort in Sub Saharan Africa: Association with HIV and antiretroviral therapy.

Author information

1
Division of Therapeutic Immunology, Department of Laboratory Medicine (LABMED), Karolinska Institutet, and the center for allogeneic stem cell transplantation, (CAST), Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
2
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
3
Management and development for health (MDH), Dar es Salaam.
4
Division of Therapeutic Immunology, Department of Laboratory Medicine (LABMED), Karolinska Institutet, and the center for allogeneic stem cell transplantation, (CAST), Karolinska University Hospital, Stockholm, Sweden.
5
Department of Global health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
6
Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom, UK.
7
Division of Therapeutic Immunology, Department of Laboratory Medicine (LABMED), Karolinska Institutet, and the center for allogeneic stem cell transplantation, (CAST), Karolinska University Hospital, Stockholm, Sweden. Electronic address: markus.maeurer@ki.se.
8
Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.

Abstract

OBJECTIVE:

Nine out of ten tuberculosis deaths occur in tuberculosis-burdened countries, particularly Sub Saharan Africa. In these setting mortality has not been fully described. We describe the magnitude and pattern of TB mortality in Tanzania.

METHODS:

A multicenter prospective cohort study was conducted among HIV infected and uninfected pulmonary tuberculosis patients from time of anti-TB treatment initiation to completion. Patients were censored at the time of treatment completion, or at their last visit for those who did not complete TB treatment. Kaplan-Meier curves were used to estimate time to death; cox proportional hazards model was used to examine risk factors for mortality.

RESULTS:

A total of 58 deaths out of 1696 patients (3.4%) occurred, two thirds (n=39) during the first two months of treatment. Compared to HIV un-infected TB patients, mortality risk for TB/HIV co-infected patients was least when antiretroviral therapy (ART) was initiated after 14 days of anti-TB (RR=3.55; 95% CI: 1.44, 8.73 p<0.0001) and highest when ART was initiated 90 days or less prior to anti-TB and within the first 14 days of anti-TB therapy (RR=10; 95% CI: 3.28, 30.54; p<0.0001).

CONCLUSION:

Meticulously planned and supervised antiretroviral therapy reduces mortality among TB/HIV patients. Among patients with TB/HIV naïve of ART, withholding ART until the third week of anti-tuberculosis therapy will likely reduce TB mortality in Tanzania. Patients on ART and later develop tuberculosis should be closely monitored.

KEYWORDS:

ART; ARV; Antiretroviral therapy; HIV; TB; TB/HIV; death; survival; treatment outcome

PMID:
28161460
DOI:
10.1016/j.ijid.2017.01.023
[Indexed for MEDLINE]
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