title: Risk factors for mortality among HIV-positive patients with and without active tuberculosis in Dar es Salaam, Tanzania.
abstract: BACKGROUND
  The aim of this study was to describe risk factors for mortality and clinical characteristics of HIV-infected patients with and without tuberculosis (TB) coinfection.
  
  
  METHODS
  A cohort of HIV-infected patients with CD4(+) T-cell counts of ≤200 cells/μl was recruited, consisting of 255 HIV-infected patients without active TB and 231 patients with active TB. All received a well-supervised treatment with an efavirenz-based HAART, and those coinfected with TB received appropriate anti-TB treatment. They were followed up for 48 weeks after HAART initiation.
  
  
  RESULTS
  Common presenting symptoms in HIV-only patients were fever (36.5%), headache (34.5%), skin rash (34.5%) and weight loss (32%), while in HIV-TB patients the symptoms were weight loss (58%), cough (57.6%), night sweats (44.6%) and fever (34.2%). HIV-TB patients had significantly lower body mass index, Karnofsky scores and haemoglobin levels compared to those infected with HIV only, despite similar baseline CD4(+) T-cell counts. Overall, 12 (4.7%) HIV patients developed TB and 7 (3%) HIV-TB patients had worsening of their TB symptoms during the study period. Mortality was similar in the two groups, being 10.9% (16 deaths per 100 person years) and 11.3% (17 deaths per 100 person years) in HIV-only and HIV-TB patients, respectively. Overall, more males (13.1%) died compared to females (9.6%). Predictors of mortality were presence of oral candidiasis, Kaposi's sarcoma, low Karnofsky score, and low baseline white blood cell and CD4(+) T-cell counts.
  
  
  CONCLUSIONS
  The outcomes following well-supervised treatment of HIV-TB patients are similar to those in patients with HIV alone. Predictors of mortality were those of advanced disease.
authors.affiliation: Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Sabina F
authors.initials: SF
authors.lastname: Mugusi
authors.forename: Eliford
authors.initials: E
authors.lastname: Ngaimisi
authors.forename: Mohamed Y
authors.initials: MY
authors.lastname: Janabi
authors.forename: Ferdinand M
authors.initials: FM
authors.lastname: Mugusi
authors.forename: Omary M S
authors.initials: OM
authors.lastname: Minzi
authors.forename: Philip G
authors.initials: PG
authors.lastname: Sasi
authors.forename: Muhammad
authors.initials: M
authors.lastname: Bakari
authors.forename: Lars
authors.initials: L
authors.lastname: Lindquist
authors.forename: Eleni
authors.initials: E
authors.lastname: Aklillu
authors.forename: Eric G
authors.initials: EG
authors.lastname: Sandstrom
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality; D000328:Adult; D000480:Alkynes; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D002180:Candidiasis, Oral / Q000150:complications / Q000401:mortality; D015331:Cohort Studies; D060085:Coinfection; D003521:Cyclopropanes; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000401:mortality* / Q000473:pathology; D006801:Humans; D017567:Karnofsky Performance Status; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000150:complications / Q000401:mortality; D013636:Tanzania; D014376:Tuberculosis / Q000150:complications / Q000401:mortality* / Q000473:pathology
chemical_list: D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; C098320:efavirenz