Long-term outcome in patients registered with tuberculosis in Zomba, Malawi: mortality at 7 years according to initial HIV status and type of TB
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.
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: 01 July 2004
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