Does Antiretroviral Treatment Reduce Case Fatality Among HIV-Positive Patients with Tuberculosis in Malawi?

Hdl Handle:
http://hdl.handle.net/10144/19396
Title:
Does Antiretroviral Treatment Reduce Case Fatality Among HIV-Positive Patients with Tuberculosis in Malawi?
Authors:
Zachariah, R; Fitzgerald, M; Massaquoi, M; Acabu, A; Chilomo, D; Salaniponi, F M L; Harries, A D
Journal:
International Journal of Tuberculosis and Lung Disease
Abstract:
SETTING: Thyolo district, 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.
Affiliation:
Medical Department (Operational Research), Médecins sans Frontières, Brussels Operational Centre, Luxembourg. zachariah@internet.lu
Issue Date:
Aug-2007
URI:
http://hdl.handle.net/10144/19396
PubMed ID:
17705949
Additional Links:
http://www.ingentaconnect.com/content/iuatld/ijtld
Language:
en
ISSN:
1027-3719
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorZachariah, R-
dc.contributor.authorFitzgerald, M-
dc.contributor.authorMassaquoi, M-
dc.contributor.authorAcabu, A-
dc.contributor.authorChilomo, D-
dc.contributor.authorSalaniponi, F M L-
dc.contributor.authorHarries, A D-
dc.date.accessioned2008-02-29T08:56:36Z-
dc.date.available2008-02-29T08:56:36Z-
dc.date.issued2007-08-
dc.identifier.citationDoes Antiretroviral Treatment Reduce Case Fatality Among HIV-Positive Patients with Tuberculosis in Malawi? 2007, 11 (8):848-53 Int. J. Tuberc. Lung Dis.en
dc.identifier.issn1027-3719-
dc.identifier.pmid17705949-
dc.identifier.urihttp://hdl.handle.net/10144/19396-
dc.description.abstractSETTING: Thyolo district, 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.en
dc.language.isoenen
dc.relation.urlhttp://www.ingentaconnect.com/content/iuatld/ijtlden
dc.rightsArchived on this site with the kind permission of the International Union Against TB and Lung Disease, http://www.iuatld.orgen
dc.titleDoes Antiretroviral Treatment Reduce Case Fatality Among HIV-Positive Patients with Tuberculosis in Malawi?en
dc.contributor.departmentMedical Department (Operational Research), Médecins sans Frontières, Brussels Operational Centre, Luxembourg. zachariah@internet.luen
dc.identifier.journalInternational Journal of Tuberculosis and Lung Diseaseen

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