title: Long-term outcome in patients registered with tuberculosis in Zomba, Malawi: mortality at 7 years according to initial HIV status and type of TB.
abstract: METHODS
  Zomba Central Hospital, Malawi.
  
  
  OBJECTIVE
  To determine the outcome of all adult patients who were registered for tuberculosis (TB) treatment 7 years previously according to initial human immunodeficiency virus (HIV) status and type of TB.
  
  
  METHODS
  A retrospective cohort study of adult patients registered for TB treatment between July and December 1995. Follow-up at patients' homes was performed at the end of treatment, at 32 months and at 84 months (7 years) from the time of TB registration.
  
  
  RESULTS
  Eight hundred and twenty-seven TB patients were registered: 793 had concordant HIV test results, of whom 612 (77%) were HIV-positive. At 7 years, 136 (17%) patients were alive, 539 (65%) had died and 152 (18%) were lost to follow-up. The death rate for all TB patients was 23.7 per 100 person-years of observation. HIV-positive patients had higher death rates than HIV-negative patients (hazard ratio [HR] 2.2, 95% confidence interval [95%CI] 1.7-2.8). Death rates in smear-negative pulmonary TB patients (HR 2.1, 95%CI 1.7-2.6) and in patients with extra-pulmonary TB (HR 1.7, 95% CI 1.3-2.0) were higher than in patients with smear-positive PTB.
  
  
  CONCLUSIONS
  There was a high mortality rate in TB patients during and after anti-tuberculosis treatment. Adjunctive treatments to reduce death rates are urgently needed.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: C T
authors.initials: CT
authors.lastname: Kang'ombe
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.forename: K
authors.initials: K
authors.lastname: Ito
authors.forename: T
authors.initials: T
authors.lastname: Clark
authors.forename: T E
authors.initials: TE
authors.lastname: Nyirenda
authors.forename: W
authors.initials: W
authors.lastname: Aldis
authors.forename: P P
authors.initials: PP
authors.lastname: Nunn
authors.forename: R D
authors.initials: RD
authors.lastname: Semba
authors.forename: F M L
authors.initials: FM
authors.lastname: Salaniponi
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D013183:Sputum / Q000166:cytology; D016019:Survival Analysis; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000401:mortality* / Q000821:virology*
chemical_list: D000995:Antitubercular Agents