Mortality similar with or without TB in HIV+ of Dar es Salaam on ART
HIV-positive adults with active tuberculosis when starting antiretroviral therapy (ART) in Dar es Salaam, Tanzania had a similar death rate as people without active TB 48 weeks after treatment began.
TB is a leading cause of death in HIV-positive people across sub-Saharan Africa. To identify mortality risk factors and clinical characteristics of HIV-positive people with and without active TB, researchers undertook this study of adults starting ART.
Dar es Salaam, Tanzania’s largest city, has a population of 2.5 million. UNAIDS estimates that Tanzania has an adult HIV prevalence of 5.6%.
The 255 people without active TB and the 231 with active TB all began treatment with a CD4 count below 200 cells/μL. All study participants received a well-supervised efavirenz-based regimen, and everyone with TB received appropriate anti-TB therapy.
The most frequent presenting symptoms in people without active TB were fever (36.5%), headache (34.5%), rash (34.5%), and weight loss (32%). In the group with active TB, the most common presenting symptoms were weight loss (58%), cough (57.6%), night sweats (44.6%) and fever (34.2%).
Although pre-ART CD4 counts were similar in the two groups, people with active TB had significantly lower body mass index, hemoglobin, and Karnofsky scores (a measure of overall health).
TB developed in 12 people (4.7%) without TB when the study began, and TB symptoms worsened in 7 people (3%) who had TB when the study began.
Mortality in the first 48 weeks of treatment was similar in the two groups: 10.9% (16 deaths per 100 person-years) in people without active TB when the study began, and 11.3% (17 deaths per 100 person-years) in people with active TB. A slightly higher proportion of men than women died (13.1% versus 9.6%).
Five factors raised the risk of death: oral candidiasis, Kaposi sarcoma, low Karnofsky score, and low pre-ART white blood cell count and CD4 count.
Source: Sabina F. Mugusi, Eliford Ngaimisi, Mohamed Y. Janabi, Ferdinand M. Mugusi, Omary Minzi, Philip G. Sasi, Muhammad Bakari, Lars Lindquist, Eleni Aklillu, Eric G. Sandstrom. Risk factors for mortality among HIV-positive patients with and without active tuberculosis in Dar es Salaam, Tanzania. Antiviral Therapy. 2012; 17: 265-274.
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