title: Incidence and predictors of mortality and the effect of tuberculosis immune reconstitution inflammatory syndrome in a cohort of TB/HIV patients commencing antiretroviral therapy.
abstract: BACKGROUND
  Tuberculosis-HIV (TB-HIV) coinfection remains an important cause of mortality in antiretroviral therapy (ART) programs. In a cohort of TB-HIV-coinfected patients starting ART, we examined the incidence and predictors of early mortality.
  
  
  METHODS
  Consecutive TB-HIV-coinfected patients eligible for ART were enrolled in a cohort study at the Mulago National Tuberculosis and Leprosy Program clinic in Kampala, Uganda. Predictors of mortality were assessed using Cox proportional hazards analysis.
  
  
  RESULTS
  Three hundred and two patients [median CD4 count 53 cells/μL (interquartile range, 20-134)] were enrolled. Fifty-three patients died, 36 (68%) of these died within the first 6 months of TB diagnosis. Male sex [hazard (HR): 2.19; 95% confidence interval (CI): 1.19 to 4.03; P = 0.011], anergy to tuberculin skin test [HR: 2.59 (1.10 to 6.12); P = 0.030], a positive serum cryptococcal antigen result at enrollment (HR: 4.27; 95% CI: 1.50 to 12.13; P = 0.006) and no ART use (HR: 4.63; 95% CI: 2. 37 to 9.03; P < 0.001) were independent predictors of mortality by multivariate analysis. Six (10%) patients with TB immune reconstitution inflammatory syndrome died, and in most, an alternative contributing cause of death was identified.
  
  
  CONCLUSIONS
  Mortality among these TB-HIV-coinfected patients was high particularly when presenting with advanced HIV disease and not starting ART, reinforcing the need for timely and joint treatment for both infections. Screening for a concomitant cryptococcal infection and antifungal treatment for patients with cryptococcal antigenemia may further improve clinical outcome.
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda. worodria@yahoo.com
authors.forename: William
authors.initials: W
authors.lastname: Worodria
authors.forename: Marguerite
authors.initials: M
authors.lastname: Massinga-Loembe
authors.forename: Doreen
authors.initials: D
authors.lastname: Mazakpwe
authors.forename: Kenneth
authors.initials: K
authors.lastname: Luzinda
authors.forename: Joris
authors.initials: J
authors.lastname: Menten
authors.forename: Frank
authors.initials: F
authors.lastname: Van Leth
authors.forename: Harriet
authors.initials: H
authors.lastname: Mayanja-Kizza
authors.forename: Luc
authors.initials: L
authors.lastname: Kestens
authors.forename: Roy D
authors.initials: RD
authors.lastname: Mugerwa
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents