title: Increased mortality associated with treated active tuberculosis in HIV-infected adults in Tanzania.
abstract: Active tuberculosis (TB) among HIV-infected patients, even when successfully treated, may be associated with excess mortality. We conducted a prospective cohort study nested in a randomized TB vaccine trial to compare mortality between HIV-infected patients diagnosed and treated for TB (TB, n = 77) and HIV-infected patients within the same CD4 range, who were not diagnosed with or treated for active TB (non-TB, n = 308) in the period 2001-2008. Only twenty four subjects (6%) were on antiretroviral therapy at the beginning of this study. After accounting for covariate effects including use of antiretroviral therapy, isoniazid preventive therapy, and receipt of vaccine, we found a four-fold increase in mortality in TB patients compared with non-TB patients (adjusted Hazard Ratio 4.61; 95% Confidence Interval (CI): 1.63, 13.05). These findings suggest that treatment for TB alone is not sufficient to avert the excess mortality associated with HIV-related TB and that prevention of TB may provide a mortality benefit.
authors.affiliation: Department of Medicine, Population Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada. ckabali@bu.edu
authors.forename: Conrad
authors.initials: C
authors.lastname: Kabali
authors.forename: Lillian
authors.initials: L
authors.lastname: Mtei
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Brooks
authors.forename: Richard
authors.initials: R
authors.lastname: Waddell
authors.forename: Muhammad
authors.initials: M
authors.lastname: Bakari
authors.forename: Mecky
authors.initials: M
authors.lastname: Matee
authors.forename: Robert D
authors.initials: RD
authors.lastname: Arbeit
authors.forename: Kisali
authors.initials: K
authors.lastname: Pallangyo
authors.forename: C Fordham
authors.initials: CF
authors.lastname: von Reyn
authors.forename: C Robert
authors.initials: CR
authors.lastname: Horsburgh
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000401:mortality* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013636:Tanzania / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000276:immunology / Q000401:mortality* / Q000628:therapy; D032581:Tuberculosis Vaccines; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D032581:Tuberculosis Vaccines