title: Mortality and loss to follow-up among tuberculosis and HIV co-infected patients in rural southwestern Uganda.
abstract: BACKGROUND
  We describe the presentation and outcome of care among patients with tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection from a prospective observational cohort in Uganda.
  
  
  METHODS
  We analysed basic demographics, CD4+ counts, time of initiating antiretroviral  therapy (ART), clinical and haematological parameters and outcome of care of 386 patients enrolled between February 2007 and March 2010.
  
  
  RESULTS
  At presentation, 56.7% of the patients were sputum-positive, 89.9% had new TB infection, 62.7% had wasting, 78.7% were anaemic, 72.1% had a CD4+  count of <200 cells/mm(3), 20.2% had pneumonia, 50.3% had oral thrush and 1.3% had Kaposi's sarcoma. Patients developing TB within 3 months of starting ART were less likely to have wasting, to be anaemic or to have a CD4+ count of <100 cells/mm(3). The cure, default  and death rates were respectively 54.3%, 24% and 16%. At 8 months, 53 (13.7%) were confirmed dead, 119 (30.8%) were lost to follow-up, 28 (7.3%) were transferred out and 1 (0.3%) had treatment failure. Mortality and loss to follow-up were associated with failure to start ART and having a CD4+  count of <200 cells/mm(3).
  
  
  CONCLUSIONS
  In Uganda, TB-HIV patients present with severe immune suppression and are at increased risk of death and loss to follow-up, particularly those not on ART. There is need for early identification and improved follow-up of TB-HIV co-infected  patients.
authors.affiliation: Infectious Diseases Clinic, Mbarara University of Science and Technology, Mbarara, Uganda. dnansera@yahoo.co.uk
authors.forename: D
authors.initials: D
authors.lastname: Nansera
authors.forename: F
authors.initials: F
authors.lastname: Bajunirwe
authors.forename: P
authors.initials: P
authors.lastname: Elyanu
authors.forename: C
authors.initials: C
authors.lastname: Asiimwe
authors.forename: G
authors.initials: G
authors.lastname: Amanyire
authors.forename: F M
authors.initials: FM
authors.lastname: Graziano
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents