Cohort study of human immunodeficiency virus infection in patients with tuberculosis in Nairobi, Kenya. Analysis of early (6-month) mortality.
Retrospective studies suggest that the mortality rate from HIV-1-associated tuberculosis is greater than that from tuberculosis alone, but it is not clear if this is due to failure of antituberculosis treatment or to the complications of HIV-1 infection. We have carried out a prospective cohort study of patients with tuberculosis in Nairobi, Kenya, to compare mortality rates, risk factors, and causes of death in HIV-1 positive and HIV-1 negative patients. One hundred seven HIV-1 positive and 174 HIV-1 negative patients with tuberculosis attending two tuberculosis treatment centers in Nairobi were enrolled and followed monthly. Mortality was significantly higher in HIV-1 positive than in HIV-1 negative patients within 6 months of the start of antituberculosis treatment after adjustment for age, sex, and education (rate ratio = 3.8; 95% confidence interval, 1.7 to 8.1; p less than 0.001). Most of the excess mortality occurred after the first month of treatment and was due to nontuberculous infections. Predictors for mortality differed greatly between HIV-1 positive and HIV-1 negative patients. Mortality was greater in HIV-1 positive patients treated with a "standard" regimen for tuberculosis than in HIV-1 positive patients receiving a "short-course" regimen (p = 0.08 when adjusted for all independent risk factors). Tuberculosis control programs in developing countries need to implement "short-course" regimens and train health workers to recognize and treat nontuberculous infections to maintain their effectiveness in the face of the HIV epidemic.
Nunn
P
P
Kenya Medical Research Institute, Nairobi.
Brindle
R
R
Carpenter
L
L
Odhiambo
J
J
Wasunna
K
K
Newnham
R
R
Githui
W
W
Gathua
S
S
Omwega
M
M
McAdam
K
K
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000401:mortality*; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000401:mortality*; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000401:mortality*
D000995:Antitubercular Agents