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Does Antiretroviral Treatment Reduce Case Fatality Among HIV-Positive Patients with Tuberculosis in Malawi?

By R Zachariah, M Fitzgerald, M Massaquoi, A Acabu, D Chilomo, F M L Salaniponi and A D Harries


SETTING: Thyolo district, Malawi. OBJECTIVES: To report on 1) case fatality among human immunodeficiency virus (HIV) positive tuberculosis (TB) patients while on anti-tuberculosis treatment and 2) whether antiretroviral treatment (ART) initiated during the continuation phase of TB treatment reduces case fatality. DESIGN: Retrospective cohort analysis. METHODS: Comparative analysis of treatment outcomes for TB patients registered between January and December 2004. RESULTS: Of 983 newly registered TB patients receiving diagnostic HIV testing, 658 (67%) were HIV-positive. A total of 132 (20%) patients died during the 8-month course of anti-tuberculosis treatment, of whom 82 (62%) died within the first 2 months of treatment when ART was not provided (cumulative incidence 3.0, 95%CI 2.5-3.6 per 100 person-years). A total of 576 TB patients started the continuation phase of anti-tuberculosis treatment, 180 (31%) of whom were started on ART. The case-fatality rate per 100 person-years was not significantly different for patients on ART (1.0, 95%CI 0.6-1.7) and those without ART (1.2, 95%CI 0.9-1.7, adjusted hazard ratio 0.86, 95%CI 0.4-1.6, P = 0.6) CONCLUSIONS: ART provided in the continuation phase of TB treatment does not have a significant impact on reducing case fatality. Reasons for this and possible measures to reduce high case fatality in the initial phase of TB treatment are discussed

Year: 2007
OAI identifier:
Provided by: MSF Field Research

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  7. (2001). Harries A D. Tuberculosis case fatality rates in HIV prevalence populations in sub-Saharan Africa. AIDS
  8. (1999). HIV and tuberculosis in rural sub-Saharan Africa: a cohort study with two year follow up. Trans Roy Soc Trop Med Hyg
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  12. Long term outcomes in patients registered with TB in
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  14. (2002). Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans Roy Soc Trop Med
  15. (2006). Organization. Improving the diagnosis and treatment of smear-negative pulmonary and extrapulmonary tuberculosis among adults and adolescents. Recommendations for HIV-prevalent and resource-constrained settings.
  16. (2005). Organization. Scaling up antiretroviral therapy in resource-limited settings. Treatment guidelines for a public health approach.
  17. (2004). Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa. AIDS
  18. (2002). Prognosis of HIV-1 infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet
  19. (2006). Providing HIV care for tuberculosis patients in sub-Saharan Africa. Int J Tuberc Lung Dis
  20. (2005). Scaling up antiretroviral therapy in Africa: learning from tuberculosis control programmes—the case of Malawi. Int J Tuberc Lung Dis
  21. (2006). Tuberculosis immune reconstitution inflammatory syndrome in countries with limited resources.
  22. (2003). Voluntary counseling, HIV testing and adjunctive cotrimoxazole reduces mortality in tuberculosis patients in Thyolo,
  23. World Health Organization. Treatment of tuberculosis: guidelines for national programmes. 3rd ed.
  24. (2006). XDR-TB: entering the post-antibiotic era?
  25. (2004). years according to initial HIV status and type of TB.

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