title: Tuberculosis mortality in HIV-infected individuals: a cross-national systematic assessment.
abstract: OBJECTIVE
  Tuberculosis (TB) is a leading cause of death in human immunodeficiency virus (HIV)-positive individuals. We sought to compare mortality rates in TB/HIV co-infected individuals globally and by country/territory.
  
  
  METHODS
  We conducted a cross-national systematic assessment.
  
  
  METHODS
  TB mortality rates in HIV-positive and HIV-negative individuals were obtained from the World Health Organization (WHO) Stop TB department for 212 recognized countries/territories in the years 2006-2008. Multivariate linear regression determined the impact of health care resource and economic variables on our outcome variable, and TB mortality rates.
  
  
  RESULTS
  In 2008, an estimated 13 TB/HIV deaths occurred per 100,000 population globally with the African region having the highest death rate ([AFRH] ≥4% adult HIV-infection rate) at 86 per 100,000 individuals. The next highest rates were for the Eastern European Region (EEUR) and the Latin American Region (LAMR) at 4 and 3 respectively per 100,000 population. African countries' HIV-positive TB mortality rates were 29.9 times higher than non-African countries (95% confidence interval [CI]: 16.8-53.4). Every US$100 of government per capita health expenditure was associated with a 33% (95% CI: 24%-42%) decrease in TB/HIV mortality rates. The multivariate model also accounted for calendar year and did not include highly active antiretroviral therapy (HAART) coverage.
  
  
  CONCLUSIONS
  Our results indicate that while the AFRH has the highest TB/HIV death rates, countries in EEUR and LAMR also have elevated mortality rates. Increasing health expenditure directed towards universal HAART access may reduce mortality from both diseases.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Au-Yeung
authors.forename: Steve
authors.initials: S
authors.lastname: Kanters
authors.forename: Erin
authors.initials: E
authors.lastname: Ding
authors.forename: Philippe
authors.initials: P
authors.lastname: Glaziou
authors.forename: Aranka
authors.initials: A
authors.lastname: Anema
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Cooper
authors.forename: Julio Sg
authors.initials: JS
authors.lastname: Montaner
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills