Factors associated with mortality in HIV-infected and uninfected patients with pulmonary tuberculosis.
BACKGROUND
HIV has fuelled the TB epidemic in sub-Saharan Africa. Mortality in patients co-infected with TB and HIV is high. Managing factors influencing mortality in TB patients might help reducing it. This study investigates factors associated with mortality including patients' HIV sero-status, CD4 cell count, laboratory, nutritional and demographic characteristics in AFB smear positive pulmonary TB patients.


METHODS
We studied 887 sputum smear positive PTB patients, between 18 and 65 years of age receiving standard 8 months anti-TB treatment. Demographic, anthropometric and laboratory data including HIV, CD4 and other tests were collected at baseline and at regular intervals. Patients were followed for a median period of 2.5 years.


RESULTS
Of the 887 participants, 155 (17.5%) died, of whom 90.3% (140/155) were HIV-infected, a fatality of 29.7% (140/471) compared to 3.6% (15/416) among HIV-uninfected. HIV infection, age, low Karnofsky score, CD4 cell counts and hemoglobin, high viral load, and oral thrush were significantly associated with high mortality in all patients.


CONCLUSIONS
Mortality among HIV-infected TB patients is high despite the use of effective anti-TB therapy. Most deaths occur after successful completion of therapy, an indication that patients die from causes other than TB. HIV infection is the strongest independent predictor of mortality in this cohort.
Mugusi
Ferdinand M
FM
Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. fmugusi@muhas.ac.tz
Mehta
Saurabh
S
Villamor
Eduardo
E
Urassa
Willy
W
Saathoff
Elmar
E
Bosch
Ronald J
RJ
Fawzi
Wafaie W
WW
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000368:Aged; D000704:Analysis of Variance; D000886:Anthropometry; D000995:Antitubercular Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D055815:Young Adult
D000995:Antitubercular Agents