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BMC Public Health
Published in: BMC Public Health 1/2009

Open Access 01-12-2009 | Research article

Factors associated with mortality in HIV-infected and uninfected patients with pulmonary tuberculosis

Authors: Ferdinand M Mugusi, Saurabh Mehta, Eduardo Villamor, Willy Urassa, Elmar Saathoff, Ronald J Bosch, Wafaie W Fawzi

Published in: BMC Public Health | Issue 1/2009

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Abstract

Background

HIV has fuelled the TB epidemic in sub-Saharan Africa. Mortality in patients co-infected with TB and HIV is high. Managing factors influencing mortality in TB patients might help reducing it. This study investigates factors associated with mortality including patients' HIV sero-status, CD4 cell count, laboratory, nutritional and demographic characteristics in AFB smear positive pulmonary TB patients.

Methods

We studied 887 sputum smear positive PTB patients, between 18 and 65 years of age receiving standard 8 months anti-TB treatment. Demographic, anthropometric and laboratory data including HIV, CD4 and other tests were collected at baseline and at regular intervals. Patients were followed for a median period of 2.5 years.

Results

Of the 887 participants, 155 (17.5%) died, of whom 90.3% (140/155) were HIV-infected, a fatality of 29.7% (140/471) compared to 3.6% (15/416) among HIV-uninfected. HIV infection, age, low Karnofsky score, CD4 cell counts and hemoglobin, high viral load, and oral thrush were significantly associated with high mortality in all patients.

Conclusion

Mortality among HIV-infected TB patients is high despite the use of effective anti-TB therapy. Most deaths occur after successful completion of therapy, an indication that patients die from causes other than TB. HIV infection is the strongest independent predictor of mortality in this cohort.
Literature
1.
Narain JP, Lo YR: Epidemiology of HIV-TB in Asia. Indian J Med Res. 2004, 120 (4): 277-289.PubMed
2.
WHO: Global Tuberculosis Control: surveillance, planning, financing. 2008, Geneva: World Health Organization
3.
Chaisson RE, Martinson NA: Tuberculosis in Africa--combating an HIV-driven crisis. N Engl J Med. 2008, 358 (11): 1089-1092. 10.1056/NEJMp0800809.CrossRefPubMed
4.
Ansari NA, Kombe AH, Kenyon TA, Hone NM, Tappero JW, Nyirenda ST, Binkin NJ, Lucas SB: Pathology and causes of death in a group of 128 predominantly HIV-positive patients in Botswana, 1997-1998. Int J Tuberc Lung Dis. 2002, 6 (1): 55-63.PubMed
5.
Maniar JK, Kamath RR, Mandalia S, Shah K, Maniar A: HIV and tuberculosis: partners in crime. Indian J Dermatol Venereol Leprol. 2006, 72 (4): 276-282. 10.4103/0378-6323.26723.CrossRefPubMed
6.
Maher D, Watt CJ, Williams BG, Raviglione M, Dye C: Tuberculosis deaths in countries with high HIV prevalence: what is their use as an indicator in tuberculosis programme monitoring and epidemiological surveillance?. Int J Tuberc Lung Dis. 2005, 9 (2): 123-127.PubMed
7.
Harries AD, Hargreaves NJ, Kemp J, Jindani A, Enarson DA, Maher D, Salaniponi FM: Deaths from tuberculosis in sub-Saharan African countries with a high prevalence of HIV-1. Lancet. 2001, 357 (9267): 1519-1523. 10.1016/S0140-6736(00)04639-0.CrossRefPubMed
8.
Mukadi YD, Maher D, Harries A: Tuberculosis case fatality rates in high HIV prevalence populations in sub-Saharan Africa. AIDS. 2001, 15 (2): 143-152. 10.1097/00002030-200101260-00002.CrossRefPubMed
9.
Frieden TR: Can tuberculosis be controlled?. Int J Epidemiol. 2002, 31 (5): 894-899. 10.1093/ije/31.5.894.CrossRefPubMed
10.
Okwera A, Whalen C, Byekwaso F, Vjecha M, Johnson J, Huebner R, Mugerwa R, Ellner J: Randomised trial of thiacetazone and rifampicin-containing regimens for pulmonary tuberculosis in HIV-infected Ugandans. The Makerere University-Case Western University Research Collaboration. Lancet. 1994, 344 (8933): 1323-1328. 10.1016/S0140-6736(94)90693-9.CrossRefPubMed
11.
Elliott AM, Halwiindi B, Hayes RJ, Luo N, Mwinga AG, Tembo G, Machiels L, Steenbergen G, Pobee JO, Nunn PP, et al: The impact of human immunodeficiency virus on response to treatment and recurrence rate in patients treated for tuberculosis: two-year follow-up of a cohort in Lusaka, Zambia. J Trop Med Hyg. 1995, 98 (1): 9-21.PubMed
12.
Gustafson P, Gomes VF, Vieira CS, Samb B, Naucler A, Aaby P, Lisse I: Clinical predictors for death in HIV-positive and HIV-negative tuberculosis patients in Guinea-Bissau. Infection. 2007, 35 (2): 69-80. 10.1007/s15010-007-6090-3.CrossRefPubMed
13.
Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, Dye C: The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med. 2003, 163 (9): 1009-1021. 10.1001/archinte.163.9.1009.CrossRefPubMed
14.
Villamor E, Mugusi F, Urassa W, Bosch RJ, Saathoff E, Matsumoto K, Meydani SN, Fawzi WW: A Trial of the Effect of Micronutrient Supplementation on Treatment Outcome, T Cell Counts, Morbidity, and Mortality in Adults with Pulmonary Tuberculosis. J Infect Dis. 2008, 197 (11): 1499-1505. 10.1086/587846.CrossRefPubMedPubMedCentral
15.
Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH: The use of nitrogen mustards in the palliative treatment of cancer. Cancer. 1948, 1: 634-656. 10.1002/1097-0142(194811)1:4<634::AID-CNCR2820010410>3.0.CO;2-L.CrossRef
16.
Lohman TG, Roche AF, Martorell R: Anthropometric standardization reference manual. 1988, Champaign, IL: Human Kinetics Books
17.
WHO: Interim proposal for a WHO staging system for HIV infection and disease. Wkly Epidemiol Rec. 1990, 65: 221-224.
18.
Mukadi YDMD, Harries A: Tuberculosis case fatality rates in high HIV prevalence populations in sub-Saharan Africa. AIDS. 2001, 15: 143-152. 10.1097/00002030-200101260-00002.CrossRefPubMed
19.
Cain KP, Kanara N, Laserson KF, Vannarith C, Sameourn K, Samnang K, Qualls ML, Wells CD, Varma JK: The epidemiology of HIV-associated tuberculosis in rural Cambodia. Int J Tuberc Lung Dis. 2007, 11 (9): 1008-1013.PubMed
20.
Sterling TR, Zhao Z, Khan A, Chaisson RE, Schluger N, Mangura B, Weiner M, Vernon A, Consortium TT: Mortality in a large tuberculosis treatment trial: modifiable and non-modifiable risk factors. Int J Tuberc Lung Dis. 2006, 10 (5): 542-549.PubMed
21.
Haar CH, Cobelens FG, Kalisvaart NA, van Gerven PJ, Have van der JJ: HIV-related mortality among tuberculosis patients in The Netherlands, 1993-2001. Int J Tuberc Lung Dis. 2007, 11 (9): 1038-1041.PubMed
22.
Dheda K, Lampe FC, Johnson MA, Lipman MC: Outcome of HIV-associated tuberculosis in the era of highly active antiretroviral therapy. J Infect Dis. 2004, 190 (9): 1670-1676. 10.1086/424676.CrossRefPubMed
23.
Zachariah R, Spielmann MP, Harries AD, Salaniponi FM: Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans R Soc Trop Med Hyg. 2002, 96 (3): 291-294. 10.1016/S0035-9203(02)90103-3.CrossRefPubMed
24.
Lubart E, Lidgi M, Leibovitz A, Rabinovitz C, Segal R: Mortality of patients hospitalized for active tuberculosis in Israel. Isr Med Assoc J. 2007, 9 (12): 870-873.PubMed
25.
de Albuquerque MdeF, Ximenes RA, Lucena-Silva N, de Souza WV, Dantas AT, Dantas OM, Rodrigues LC: Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil. Cadernos de saúde pública/Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública. 2007, 23 (7): 1573-1582.CrossRef
26.
Domingos MP, Caiaffa WT, Colosimo EA: Mortality, TB/HIV co-infection, and treatment dropout: predictors of tuberculosis prognosis in Recife, Pernambuco State, Brazil. Cadernos de saúde pública/Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública. 2008, 24 (4): 887-896.
27.
Zevallos M, Justman JE: Tuberculosis in the elderly. Clin Geriatr Med. 2003, 19 (1): 121-138. 10.1016/S0749-0690(02)00057-5.CrossRefPubMed
28.
Low S, Ang LW, Cutter J, James L, Chee CB, Wang YT, Chew SK: Mortality among tuberculosis patients on treatment in Singapore. Int J Tuberc Lung Dis. 2009, 13 (3): 328-334.PubMed
29.
Glynn JR, Warndorff DK, Fine PE, Munthali MM, Sichone W, Ponnighaus JM: Measurement and determinants of tuberculosis outcome in Karonga District, Malawi. Bull World Health Organ. 1998, 76 (3): 295-305.PubMedPubMedCentral
30.
Elliott AM, Halwiindi B, Hayes RJ, Luo N, Mwinga AG, Tembo G, Machiels L, Steenbergen G, Pobee JO, Nunn P: The impact of human immunodeficiency virus on mortality of patients treated for tuberculosis in a cohort study in Zambia. Trans R Soc Trop Med Hyg. 1995, 89 (1): 78-82. 10.1016/0035-9203(95)90668-1.CrossRefPubMed
31.
Quy HT, Cobelens FG, Lan NT, Buu TN, Lambregts CS, Borgdorff MW: Treatment outcomes by drug resistance and HIV status among tuberculosis patients in Ho Chi Minh City, Vietnam. Int J Tuberc Lung Dis. 2006, 10 (1): 45-51.PubMed
32.
Reyes-Corcho A, Capo de Paz V, Díaz-Jidy M, Pérez-Avila J, Bouza-Jiménez Y: [Change in the survival of Cuban AIDS patients with tuberculosis in the Highly Active Antiretroviral Therapy (HAART) era]. Investigación clínica. 2008, 49 (3): 309-320.PubMed
33.
Moore D, Liechty C, Ekwaru P, Were W, Mwima G, Solberg P, Rutherford G, Mermin J: Prevalence, incidence and mortality associated with tuberculosis in HIV-infected patients initiating antiretroviral therapy in rural Uganda. AIDS. 2007, 21 (6): 713-719. 10.1097/QAD.0b013e328013f632.CrossRefPubMed
34.
Kourbatova EV, Borodulin BE, Borodulina EA, del Rio C, Blumberg HM, Leonard MK: Risk factors for mortality among adult patients with newly diagnosed tuberculosis in Samara, Russia. Int J Tuberc Lung Dis. 2006, 10 (11): 1224-1230.PubMed
35.
Ciglenecki I, Glynn JR, Mwinga A, Ngwira B, Zumla A, Fine PE, Nunn A: Population differences in death rates in HIV-positive patients with tuberculosis. Int J Tuberc Lung Dis. 2007, 11 (10): 1121-1128.PubMed
36.
O'Brien ME, Kupka R, Msamanga GI, Saathoff E, Hunter DJ, Fawzi WW: Anemia is an independent predictor of mortality and immunologic progression of disease among women with HIV in Tanzania. J Acquir Immune Defic Syndr. 2005, 40 (2): 219-225. 10.1097/01.qai.0000166374.16222.a2.CrossRefPubMed
37.
Mocroft A, Kirk O, Barton SE, Dietrich M, Proenca R, Colebunders R, Pradier C, dArminio Monforte A, Ledergerber B, Lundgren JD: Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe. EuroSIDA study group. Aids. 1999, 13 (8): 943-950. 10.1097/00002030-199905280-00010.CrossRefPubMed
Metadata
Title
Factors associated with mortality in HIV-infected and uninfected patients with pulmonary tuberculosis
Authors
Ferdinand M Mugusi
Saurabh Mehta
Eduardo Villamor
Willy Urassa
Elmar Saathoff
Ronald J Bosch
Wafaie W Fawzi
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2009
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-9-409

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