title: Comparison of treatment outcomes of new smear-positive pulmonary tuberculosis patients by HIV and antiretroviral status in a TB/HIV clinic, Malawi.
abstract: BACKGROUND
  Smear-positive pulmonary TB is the most infectious form of TB. Previous studies on the effect of HIV and antiretroviral therapy on TB treatment outcomes among these highly infectious patients demonstrated conflicting results, reducing understanding of important issues.
  
  
  METHODS
  All adult smear-positive pulmonary TB patients diagnosed between 2008 and 2010 in Malawi's largest public, integrated TB/HIV clinic were included in the study to assess treatment outcomes by HIV and antiretroviral therapy status using logistic regression.
  
  
  RESULTS
  Of 2,361 new smear-positive pulmonary TB patients, 86% had successful treatment outcome (were cured or completed treatment), 5% died, 6% were lost to follow-up, 1% failed treatment, and 2% transferred-out. Overall HIV prevalence was 56%. After adjusting for gender, age and TB registration year, treatment success was higher among HIV-negative than HIV-positive patients (adjusted odds ratio 1.49; 95% CI: 1.14-1.94). Of 1,275 HIV-infected pulmonary TB patients, 492 (38%) received antiretroviral therapy during the study. Pulmonary TB patients on antiretroviral therapy were more likely to have successful treatment outcomes than those not on ART (adjusted odds ratio : 1.83; 95% CI: 1.29-2.60).
  
  
  CONCLUSIONS
  HIV co-infection was associated with poor TB treatment outcomes. Despite high HIV prevalence and the integrated TB/HIV setting, only a minority of patients started antiretroviral therapy. Intensified patient education and provider training on the benefits of antiretroviral therapy could increase antiretroviral therapy uptake and improve TB treatment success among these most infectious patients.
authors: The International Union Against Tuberculosis and Lung Disease, Paris, France. h_tweya@lighthouse.org.mw
authors: Hannock
authors: H
authors: Tweya
authors: Caryl
authors: C
authors: Feldacker
authors: Sam
authors: S
authors: Phiri
authors: Anne
authors: A
authors: Ben-Smith
authors: Lukas
authors: L
authors: Fenner
authors: Andreas
authors: A
authors: Jahn
authors: Mike
authors: M
authors: Kalulu
authors: Ralf
authors: R
authors: Weigel
authors: Chancy
authors: C
authors: Kamba
authors: Rabecca
authors: R
authors: Banda
authors: Matthias
authors: M
authors: Egger
authors: Olivia
authors: O
authors: Keiser
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000150:complications / Q000188:drug therapy; D005260:Female; D006678:HIV / Q000187:drug effects / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008168:Lung / Q000382:microbiology / Q000821:virology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents