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Free Content Does antiretroviral treatment reduce case fatality among HIV-positive patients with tuberculosis in Malawi?

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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.
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Keywords: ART; HIV/AIDS; Malawi; TB; case fatality

Document Type: Regular Paper

Affiliations: 1: Medical Department (Operational Research), Médecins sans Frontières, Brussels Operational Centre, Luxembourg 2: Médecins sans Frontières, Thyolo District, Malawi 3: National TB Control Programme, Ministry of Health, Thyolo District, Malawi 4: HIV Care and Support, Ministry of Health, Lilongwe, Malawi supported by Family Health International, USA: ; and London School of Hygiene and Tropical Medicine, London, UK

Publication date: 01 August 2007

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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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