Mortality and loss to follow-up among tuberculosis and HIV co-infected patients in rural southwestern Uganda
Abstract:BACKGROUND: We describe the presentation and outcome of care among patients with tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection from a prospective observational cohort in Uganda.
METHODS: We analysed basic demographics, CD4+ counts, time of initiating antiretroviral therapy (ART), clinical and haematological parameters and outcome of care of 386 patients enrolled between February 2007 and March 2010.
RESULTS: At presentation, 56.7% of the patients were sputum-positive, 89.9% had new TB infection, 62.7% had wasting, 78.7% were anaemic, 72.1% had a CD4+ count of <200 cells/mm3, 20.2% had pneumonia, 50.3% had oral thrush and 1.3% had Kaposi's sarcoma. Patients developing TB within 3 months of starting ART were less likely to have wasting, to be anaemic or to have a CD4+ count of <100 cells/mm3. The cure, default and death rates were respectively 54.3%, 24% and 16%. At 8 months, 53 (13.7%) were confirmed dead, 119 (30.8%) were lost to follow-up, 28 (7.3%) were transferred out and 1 (0.3%) had treatment failure. Mortality and loss to follow-up were associated with failure to start ART and having a CD4+ count of <200 cells/mm3.
CONCLUSION: In Uganda, TB-HIV patients present with severe immune suppression and are at increased risk of death and loss to follow-up, particularly those not on ART. There is need for early identification and improved follow-up of TB-HIV co-infected patients.
Document Type: Research Article
Affiliations: 1: Infectious Diseases Clinic, Mbarara University of Science and Technology, Mbarara, Uganda 2: Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda 3: Mulago-Mbarara Teaching Hospitals Joint AIDS Programme, Uganda, Mbarara, Uganda 4: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
Publication date: 2012-10-01
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