Population differences in death rates in HIV-positive patients with tuberculosis.
METHODS
Randomised controlled clinical trial of Mycobacterium vaccae vaccination as an adjunct to anti-tuberculosis treatment in human immunodeficiency virus (HIV) positive patients with smear-positive tuberculosis (TB) in Lusaka, Zambia, and Karonga, Malawi.


OBJECTIVE
To explain the difference in mortality between the two trial sites and to identify risk factors for death among HIV-positive patients with TB.


METHODS
Information on demographic, clinical, laboratory and radiographic characteristics was collected. Patients in Lusaka (667) and in Karonga (84) were followed up for an average of 1.56 years. Cox proportional hazard analyses were used to assess differences in survival between the two sites and to determine risk factors associated with mortality during and after anti-tuberculosis treatment.


RESULTS
The case fatality rate was 14.7% in Lusaka and 21.4% in Karonga. The hazard ratio for death comparing Karonga to Lusaka was 1.47 (95% confidence interval [CI] 0.9-2.4) during treatment and 1.76 (95%CI 1.0-3.0) after treatment. This difference could be almost entirely explained by age and more advanced HIV disease among patients in Karonga.


CONCLUSIONS
It is important to understand the reasons for population differences in mortality among patients with TB and HIV and to maximise efforts to reduce mortality.
Ciglenecki
I
I
Médecins Sans Frontières, Geneva, Switzerland. iza_ciglenecki@yahoo.com
Glynn
J R
JR
Mwinga
A
A
Ngwira
B
B
Zumla
A
A
Fine
P E M
PE
Nunn
A
A
D000328:Adult; D001428:Bacterial Vaccines / Q000627:therapeutic use; D002423:Cause of Death / Q000639:trends*; D004311:Double-Blind Method; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000401:mortality* / Q000517:prevention & control; D014611:Vaccination / Q000379:methods; D015024:Zambia / Q000453:epidemiology
D001428:Bacterial Vaccines; C451081:SRL172