title: Determinants of unsuccessful tuberculosis treatment outcomes in Malaysian HIV-infected patients.
abstract: OBJECTIVE
  To determine predictors of unsuccessful treatment in HIV-infected tuberculosis (TB) patients.
  
  
  METHODS
  We reviewed medical records at the time of TB diagnosis and subsequent follow-up of all registered TB patients with HIV co-infection at TB clinics in the Institute of Respiratory Medicine and three public hospitals in Malaysia between January 2010 and September 2010. We reviewed these medical records again twelve months after their initial diagnosis to determine treatment outcomes. Multiple logistic regression was conducted to identify risk factors for unsuccessful TB treatment.
  
  
  RESULTS
  Among the 219 patients analyzed, 53.4% achieved successful outcomes (cure, completed treatment) while 46.6% of patients had unsuccessful outcomes (default, treatment failure, died). After adjusting for other factors, unsuccessful outcome was associated with intravenous drug use (OR 2.72; 95% CI 1.44-5.16), not receiving antiretroviral therapy (OR 5.10; 95% CI 2.69-9.69), lymphadenopathy (OR 2.01; 95% CI 1.09-3.72) and low serum albumin (OR 4.61; 95% CI 1.73-12.27).
  
  
  CONCLUSIONS
  Anti-retroviral treatment must be provided to all HIV-infected tuberculosis patients. Good immune and nutritional status needs to be assured in all HIV-infected tuberculosis patients. More studies are required in intravenous drug users to understand why tuberculosis treatment outcomes are poor in this group.
authors.affiliation: Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya 50603 Kuala Lumpur, Malaysia. drismawati@gmail.com
authors.forename: Ismawati
authors.initials: I
authors.lastname: Ismail
authors.forename: Awang
authors.initials: A
authors.lastname: Bulgiba
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000382:microbiology; D006801:Humans; D016015:Logistic Models; D008206:Lymphatic Diseases / Q000150:complications; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D015819:Substance Abuse, Intravenous / Q000150:complications; D017211:Treatment Failure; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy
chemical_list: D019380:Anti-HIV Agents; D012709:Serum Albumin
keywords: HIV; Prognosis; Treatment outcome; Tuberculosis