Document Detail


Does antiretroviral treatment reduce case fatality among HIV-positive patients with tuberculosis in Malawi?
MedLine Citation:
PMID:  17705949     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
R Zachariah; M Fitzgerald; M Massaquoi; A Acabu; D Chilomo; F M L Salaniponi; A D Harries
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease     Volume:  11     ISSN:  1027-3719     ISO Abbreviation:  Int. J. Tuberc. Lung Dis.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706389     Medline TA:  Int J Tuberc Lung Dis     Country:  France    
Other Details:
Languages:  eng     Pagination:  848-53     Citation Subset:  IM    
Affiliation:
Medical Department (Operational Research), Médecins sans Frontières, Brussels Operational Centre, Luxembourg. zachariah@internet.lu
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Comment In:
Int J Tuberc Lung Dis. 2007 Aug;11(8):827   [PMID:  17705946 ]

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