title: Tuberculosis Case Fatality and Other Causes of Death among Multidrug-Resistant Tuberculosis Patients in a High HIV Prevalence Setting, 2000-2008, South Africa.
abstract: BACKGROUND
  South Africa has the highest reported rates of multi-drug resistant TB in Africa, typified by poor treatment outcomes, attributable mainly to high default and death rates. Concomitant HIV has become the strongest predictor of death among MDR-TB patients, while anti-retroviral therapy (ART) has dramatically reduced mortality. TB Case fatality rate (CFR) is an indicator that specifically reports on deaths due to TB.
  
  
  OBJECTIVE
  The aim of this paper was to investigate causes of death amongst MDR-TB patients, the contribution of conditions other than TB to deaths, and to determine if causes differ between HIV-uninfected patients, HIV-infected patients receiving ART and those without ART.
  
  
  METHODS
  We carried out a retrospective review of data captured from the register of the MDR-TB programme of the North West Province, South Africa. We included 671 patients treated between 2000-2008; 59% of the cohort was HIV-infected and 33% had received ART during MDR treatment. The register contained data on treatment outcomes and causes of death.
  
  
  RESULTS
  Treatment outcomes between HIV-uninfected cases, HIV-infected cases receiving ART and HIV-infected without ART differed significantly (p<0.000). The cohort death rate was 24%, 13% for HIV-uninfected cases and 31% for HIV-infected cases. TB caused most of the deaths, resulting in a cohort CFR of 15%, 9% for HIV-uninfected cases and 20% for HIV-infected cases. Cohort mortality rate due to other conditions was 2%. AIDS-conditions rather than TB caused significantly more deaths among HIV-infected cases receiving ART than those not (p = 0.02).
  
  
  CONCLUSIONS
  The deaths among HIV-infected individuals contribute substantially to the high death rate. ART co-therapy protected HIV-infected cases from death due to TB and AIDS-conditions. Mechanisms need to be in place to ensure that HIV-infected individuals are retained in care upon completion of their MDR-TB treatment.
authors.affiliation: Tuberculosis Platform, South African Medical Research Council, Pretoria, South Africa.
authors.forename: Martie
authors.initials: M
authors.lastname: van der Walt
authors.affiliation: Tuberculosis Platform, South African Medical Research Council, Pretoria, South Africa.
authors.forename: Joey
authors.initials: J
authors.lastname: Lancaster
authors.affiliation: Tuberculosis Platform, South African Medical Research Council, Pretoria, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Shean
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D002423:Cause of Death; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D015995:Prevalence; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000401:mortality*
chemical_list: D019380:Anti-HIV Agents