Does antiretroviral treatment reduce case fatality among HIV-positive patients with tuberculosis in Malawi?
METHODS
Thyolo district, Malawi.


OBJECTIVE
To report on 1) case fatality among human immunodeficiency virus (HIV) positive tuberculosis (TB) patients while on anti-tuberculosis treatment and 2) whether antiretroviral treatment (ART) initiated during the continuation phase of TB treatment reduces case fatality.


METHODS
Retrospective cohort analysis.


METHODS
Comparative analysis of treatment outcomes for TB patients registered between January and December 2004.


RESULTS
Of 983 newly registered TB patients receiving diagnostic HIV testing, 658 (67%) were HIV-positive. A total of 132 (20%) patients died during the 8-month course of anti-tuberculosis treatment, of whom 82 (62%) died within the first 2 months of treatment when ART was not provided (cumulative incidence 3.0, 95%CI 2.5-3.6 per 100 person-years). A total of 576 TB patients started the continuation phase of anti-tuberculosis treatment, 180 (31%) of whom were started on ART. The case-fatality rate per 100 person-years was not significantly different for patients on ART (1.0, 95%CI 0.6-1.7) and those without ART (1.2, 95%CI 0.9-1.7, adjusted hazard ratio 0.86, 95%CI 0.4-1.6, P = 0.6)


CONCLUSIONS
ART provided in the continuation phase of TB treatment does not have a significant impact on reducing case fatality. Reasons for this and possible measures to reduce high case fatality in the initial phase of TB treatment are discussed.
Zachariah
R
R
Medical Department (Operational Research), Médecins sans Frontières, Brussels Operational Centre, Luxembourg. zachariah@internet.lu
Fitzgerald
M
M
Massaquoi
M
M
Acabu
A
A
Chilomo
D
D
Salaniponi
F M L
FM
Harries
A D
AD
D000995:Antitubercular Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000453:epidemiology; D006679:HIV Seropositivity; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D012189:Retrospective Studies; D014376:Tuberculosis / Q000453:epidemiology
D000995:Antitubercular Agents