Chilomo, D

Harries, A D

Massaquoi, M

Zachariah, Rony

English

MSF Field Research

DOES ANTIRETROVIRAL TREATMENT REDUCE CASE-FATALITY AMONG HIV-
POSITIVE PATIENTS WITH TUBERCULOSIS IN MALAWI? 
Zachariah.R
1   Fitzgerald. M
2  Massaquoi. M
1Acabu.A
1 Chilomo.D
3 Salaniponi. FML
3 
Harries. AD
4 
1 Medecins sans Frontieres, Medical department (Operational Research), Brussels Operational Center, Belgium 
2. Medecins sans Frontieres, Thyolo District, Malawi
 
3 National TB control program, Ministry of Health, Thyolo district, Malawi 
 
4 National Technical advisor, HIV care and support,  Ministry of Health,  Lilongwe, Malawi (supported by Family Health International, 
USA),  and Honorary Professor, London School of Hygiene and Tropical Medicine, UK.
 
 
SETTING: Thyolo district, Malawi. 
OBJECTIVES: To report on a) case-fatality among HIV-positive Tuberculosis(TB) patients while on anti-
TB treatment and b) whether antiretroviral treatment (ART) initiated during the continuation phase of TB 
treatment reduces the case-fatality  
DESIGN:  Retrospective cohort analysis.  
METHODS:  Comparative analysis of treatment outcomes for TB patients registered between January 
and  December 2004.. 
RESULTS: There were 983 newly registered TB patients, of whom 658(67%) were HIV-positive. A total 
of 132(20%) patients died during the 8 month course of anti-TB treatment of whom 82(62%) died within 
the first 2 months of treatment (initial phase)  when ART was not provided (cumulative incidence=3.0, 
95%CI: 2.5-3.6 per 100 person-years). There were 576 TB patients who completed the initial two 
months of anti-TB treatment of whom 180(31%) chose to start ART. The case fatality rate per 100 
person-years among those accepting ART (1.0, 95% CI:0.6-1.7) was not significantly different to 
patients not accepting 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. Additional measures to address high early mortality in HIV-positive TB 
patients are urgently needed.  
 
KEY WORDS: MALAWI, HIV/AIDS, TB, ART, CASE-FATALITY  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
FIGURE. Survival probability in relation to antiretroviral treatment (ART) during the continuation phase (months 2-8) 
of anti-tuberculosis treatment, Thyolo, Malawi.                                                   
  
0
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0
0
0
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2
5
0
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5
0
0
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7
5
1
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0
0
S
u
r
v
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v
a
l
0 2 4 6 8
Time in months since starting anti-TB treatm ent
AR T=N o ART= Yes
Survival probabilty in relation to ART
 
 
 
 
 
 
Log-rank test X² = 0.34, P=0.6  

DOES ANTIRETROVIRAL TREATMENT REDUCE CASE-FATALITY AMONG HIV-POSITIVE PATIENTS WITH TUBERCULOSIS IN MALAWI?

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