Does antiretroviral treatment reduce case fatality among HIV-positive patients with tuberculosis in 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.
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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