Loss to follow-up and mortality among HIV-infected people co-infected with TB at ART initiation in Durban, South Africa.
OBJECTIVE
To quantify the impact of tuberculosis (TB) co-infection on death and loss to follow-up (LTFU) 12 months after entry into an ART program.


METHODS
Prospective intervention study.


METHODS
From May 2007 to 2008, patients undergoing pre-ART training in Durban, South Africa, were screened for pulmonary TB using mycobacterial culture. Subjects missing appointments for >3 months were phoned. Patients who could not be reached were considered LTFU. Deaths were ascertained by report from family members. We used the Kaplan-Meier method to estimate time to LTFU or death for 3 groups at enrollment as follows: (1) newly diagnosed with TB by sputum culture; (2) on TB treatment (ie, previously diagnosed); and (3) TB free. We evaluated the role of TB on mortality and LTFU using Cox proportional hazards models.


RESULTS
Nine hundred fifty-one HIV-infected subjects were enrolled; 59% were female, and median baseline CD4 count was 90 cells per microliter (IQR: 41-148 cells/μL). One hundred forty-four (15%) were newly diagnosed with TB by sputum culture; an additional 199 (21%) were already on TB treatment. By 12 months, 26% newly diagnosed with TB at enrollment died or were LTFU, compared with 19% already on TB treatment, and 14% who were TB free (P = 0.001). Controlling for age, sex, smoking, CD4, and opportunistic infection history, subjects newly diagnosed with pulmonary TB were 76% more likely to die or be LTFU (hazard ratio: 1.76, 95% confidence interval: 1.20 to 2.60) than those without TB.


CONCLUSIONS
HIV/TB co-infected individuals are more likely to die or be LTFU within 12 months of ART clinic entry in South Africa. These patients require intensive follow-up during ART initiation.
Division of Infectious Disease, Massachusetts General Hospital, Boston, USA. ibassett@partners.org
Ingrid V
IV
Bassett
Senica
S
Chetty
Bingxia
B
Wang
Matilda
M
Mazibuko
Janet
J
Giddy
Zhigang
Z
Lu
Rochelle P
RP
Walensky
Kenneth A
KA
Freedberg
Elena
E
Losina
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D010349:Patient Compliance; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications* / Q000401:mortality*
D019380:Anti-HIV Agents