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Free Content Long-term outcome in patients registered with tuberculosis in Zomba, Malawi: mortality at 7 years according to initial HIV status and type of TB

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SETTING: Zomba Central Hospital, Malawi.

OBJECTIVES: To determine the outcome of all adult patients who were registered for tuberculosis (TB) treatment 7 years previously according to initial human immunodeficiency virus (HIV) status and type of TB.

DESIGN: A retrospective cohort study of adult patients registered for TB treatment between July and December 1995. Follow-up at patients' homes was performed at the end of treatment, at 32 months and at 84 months (7 years) from the time of TB registration.

FINDINGS: Eight hundred and twenty-seven TB patients were registered: 793 had concordant HIV test results, of whom 612 (77%) were HIV-positive. At 7 years, 136 (17%) patients were alive, 539 (65%) had died and 152 (18%) were lost to follow-up. The death rate for all TB patients was 23.7 per 100 person-years of observation. HIV-positive patients had higher death rates than HIV-negative patients (hazard ratio [HR] 2.2, 95% confidence interval [95%CI] 1.7–2.8). Death rates in smear-negative pulmonary TB patients (HR 2.1, 95%CI 1.7–2.6) and in patients with extra-pulmonary TB (HR 1.7, 95%CI 1.3–2.0) were higher than in patients with smear-positive PTB.

CONCLUSIONS: There was a high mortality rate in TB patients during and after anti-tuberculosis treatment. Adjunctive treatments to reduce death rates are urgently needed.
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Keywords: HIV infection; Malawi; extra-pulmonary TB; mortality; smear-negative TB; smear-positive TB; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 2: Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi 3: Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan 4: World Health Organization (Malawi Country Office), Lilongwe, Malawi 5: TB-HIV Group, Stop-TB, World Health Organization, Geneva, Switzerland

Publication date: July 1, 2004

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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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