IngentaConnect Population differences in death rates in HIV-positive patients wi...

Authors: Ciglenecki, I.¹; Glynn, J.R.²; Mwinga, A.³; Ngwira, B.⁴; Zumla, A.⁵; Fine, P.E.M.²; Nunn, A.⁶

Source: The International Journal of Tuberculosis and Lung Disease, Volume 11, Number 10, October 2007 , pp. 1121-1128(8)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: Randomised controlled clinical trial of Mycobacterium vaccae vaccination as an adjunct to anti-tuberculosis treatment in human immunodeficiency virus (HIV) positive patients with smear-positive tuberculosis (TB) in Lusaka, Zambia, and Karonga, Malawi.

OBJECTIVE: To explain the difference in mortality between the two trial sites and to identify risk factors for death among HIV-positive patients with TB.

DESIGN: Information on demographic, clinical, laboratory and radiographic characteristics was collected. Patients in Lusaka (667) and in Karonga (84) were followed up for an average of 1.56 years. Cox proportional hazard analyses were used to assess differences in survival between the two sites and to determine risk factors associated with mortality during and after anti-tuberculosis treatment.

RESULTS: The case fatality rate was 14.7% in Lusaka and 21.4% in Karonga. The hazard ratio for death comparing Karonga to Lusaka was 1.47 (95% confidence interval [CI] 0.9-2.4) during treatment and 1.76 (95%CI 1.0-3.0) after treatment. This difference could be almost entirely explained by age and more advanced HIV disease among patients in Karonga.

CONCLUSION: It is important to understand the reasons for population differences in mortality among patients with TB and HIV and to maximise efforts to reduce mortality.

Keywords: tuberculosis; HIV; mortality; sub-Saharan Africa

Document Type: Regular paper

Affiliations: 1: Médecins Sans Frontières, Geneva, Switzerland; London School of Hygiene & Tropical Medicine, London, UK 2: London School of Hygiene & Tropical Medicine, London, UK 3: University Teaching Hospital, Lusaka, Zambia; and Centers for Disease Control and Prevention, Lusaka, Zambia 4: Karonga Prevention Study, Karonga, Malawi 5: University College London, London, UK 6: MRC Clinical Trials Unit, London, UK

Population differences in death rates in HIV-positive patients with tuberculosis