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Free Content Impact of the human immunodeficiency virus epidemic on mortality among adults with tuberculosis in rural South Africa, 1991–1995

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SETTING: In the Hlabisa district tuberculosis programme, South Africa, the prevalence of human immunodeficiency virus (HIV) infection among adults with tuberculosis increased from 36.0% in 1993 to 65.9% in 1997, and the annual tuberculosis caseload increased from 321 in 1991 to 1250 in 1996.

OBJECTIVE: To examine the impact of the HIV epidemic on mortality among adults with tuberculosis from 1991 to 1995.

METHODS: Data were extracted from the control programme database. As the programme started in July 1991, data for this year were combined with those for 1992.

RESULTS: All-cause mortality among all those diagnosed with tuberculosis increased by 45.6%, from 9.2% (55/599) in 1991/92 to 13.4% (96/714) in 1995 (P = 0.02). Among smear-positive patients only, mortality increased by 134%, from 4.4% to 10.3% (P = 0.003). The case-fatality rate (CFR) increased in most age groups of both sexes, the largest increase (157.5%) being among women aged 15–34 years. CFR was highest among those with smear-negative disease (24.7% in 1995). In multifactorial analysis, independent risk factors for mortality were increasing age (P = 0.0001), HIV infection (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.3–5.4), smear-negative disease (OR 2.5, 95%CI 1.8–3.5), and diagnosis in 1995 vs 1991/92 (OR 1.8, 95%CI 1.2–2.7). Mortality among the HIV infected continued to accrue throughout treatment, whereas non-HIV-infected patients that died did so early in treatment.

CONCLUSION: The HIV epidemic is increasing tuberculosis all-cause mortality. As well as having a direct effect on individuals, increased caseloads due to HIV may also contribute to increased mortality by reducing the health systemÕs ability to provide adequate care.
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Keywords: Africa; HIV-related tuberculosis; mortality; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Centre for Epidemiological Research in Southern Africa, South African Medical Research Council, Hlabisa, South Africa 2: Hlabisa Hospital, Hlabisa, South Africa

Publication date: 1998-11-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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