Nagu, TJ;
Aboud, S;
Mwiru, R;
Matee, MI;
Rao, M;
Fawzi, WW;
Zumla, A;
... Mugusi, F; + view all
(2017)
Tuberculosis associated mortality in a prospective cohort in Sub Saharan Africa: Association with HIV and antiretroviral therapy.
[Review].
International Journal of Infectious Diseases
, 56
pp. 39-44.
10.1016/j.ijid.2017.01.023.
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Abstract
OBJECTIVE: Nine out of ten tuberculosis deaths occur in tuberculosis-burdened countries, particularly Sub Saharan Africa. In these setting mortality has not been fully described. We describe the magnitude and pattern of TB mortality in Tanzania. METHODS: A multicenter prospective cohort study was conducted among HIV infected and uninfected pulmonary tuberculosis patients from time of anti-TB treatment initiation to completion. Patients were censored at the time of treatment completion, or at their last visit for those who did not complete TB treatment. Kaplan-Meier curves were used to estimate time to death; cox proportional hazards model was used to examine risk factors for mortality. RESULTS: A total of 58 deaths out of 1696 patients (3.4%) occurred, two thirds (n = 39) during the first two months of treatment. Compared to HIV un-infected TB patients, mortality risk for TB/HIV co-infected patients was least when antiretroviral therapy (ART) was initiated after 14 days of anti-TB (RR = 3.55; 95% CI: 1.44, 8.73 p < 0.0001) and highest when ART was initiated 90 days or less prior to anti-TB and within the first 14 days of anti-TB therapy (RR = 10; 95% CI: 3.28, 30.54; p < 0.0001). CONCLUSION: Meticulously planned and supervised antiretroviral therapy reduces mortality among TB/ HIV patients. Among patients with TB/HIV naïve of ART, withholding ART until the third week of antituberculosis therapy will likely reduce TB mortality in Tanzania. Patients on ART and later develop tuberculosis should be closely monitored.
| Type: | Article |
|---|---|
| Title: | Tuberculosis associated mortality in a prospective cohort in Sub Saharan Africa: Association with HIV and antiretroviral therapy |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.ijid.2017.01.023 |
| Publisher version: | http://doi.org/10.1016/j.ijid.2017.01.023 |
| Language: | English |
| Additional information: | Copyright © 2017 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
| Keywords: | TB, survival, death, treatment outcome, HIV, Antiretroviral therapy, ART, TB/HIV, ARV, ART |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1551407 |
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