Increased mortality associated with treated active tuberculosis in HIV-infected adults in Tanzania
Kabali, C.; Mtei, L.; Brooks, D.R.; Waddell, R.; Bakari, M.; Matee, M.; Arbeit, R.D.; Pallangyo, K.; von Reyn, C.F.; Horsburgh, C.R.
Tuberculosis 93(4): 461-466
2013
ISSN/ISBN: 1873-281X PMID: 23523641 DOI: 10.1016/j.tube.2013.01.001Document Number: 579380
Active tuberculosis (TB) among HIV-infected patients, even when successfully treated, may be associated with excess mortality. We conducted a prospective cohort study nested in a randomized TB vaccine trial to compare mortality between HIV-infected patients diagnosed and treated for TB (TB, n = 77) and HIV-infected patients within the same CD4 range, who were not diagnosed with or treated for active TB (non-TB, n = 308) in the period 2001-2008. Only twenty four subjects (6%) were on antiretroviral therapy at the beginning of this study. After accounting for covariate effects including use of antiretroviral therapy, isoniazid preventive therapy, and receipt of vaccine, we found a four-fold increase in mortality in TB patients compared with non-TB patients (adjusted Hazard Ratio 4.61; 95% Confidence Interval (CI): 1.63, 13.05). These findings suggest that treatment for TB alone is not sufficient to avert the excess mortality associated with HIV-related TB and that prevention of TB may provide a mortality benefit.
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