Risk Factors for Mortality among HIV-Positive Patients with and without Active Tuberculosis in Dar Es Salaam,Tanzania

Abstract

Background

The aim of this study was to describe risk factors for mortality and clinical characteristics of HIV-infected patients with and without tuberculosis (TB) coinfection.

Methods

A cohort of HIV-infected patients with CD4⁺ T-cell counts of ≤200 cells/ml was recruited, consisting of 255 HIV-infected patients without active TB and 231 patients with active TB. All received a well-supervised treatment with an efavirenz-based HAART, and those coinfected with TB received appropriate anti-TB treatment. They were followed up for 48 weeks after HAART initiation.

Results

Common presenting symptoms in HIV-only patients were fever (36.5%), headache (34.5%), skin rash (34.5%) and weight loss (32%), while in HIV-TB patients the symptoms were weight loss (58%), cough (57.6%), night sweats (44.6%) and fever (34.2%). HIV-TB patients had significantly lower body mass index, Karnofsky scores and haemoglobin levels compared to those infected with HIV only, despite similar baseline CD4⁺ T-cell counts. Overall, 12 (4.7%) HIV patients developed TB and 7 (3%) HIV-TB patients had worsening of their TB symptoms during the study period. Mortality was similar in the two groups, being 10.9% (16 deaths per 100 person years) and 11.3% (17 deaths per 100 person years) in HIV-only and HIV-TB patients, respectively. Overall, more males (13.1%) died compared to females (9.6%). Predictors of mortality were presence of oral candidiasis, Kaposi's sarcoma, low Karnofsky score, and low baseline white blood cell and CD4⁺ T-cell counts.

Conclusions

The outcomes following well-supervised treatment of HIV-TB patients are similar to those in patients with HIV alone. Predictors of mortality were those of advanced disease.

References

UNAIDS. UNGASS reporting for 2010 (Tanzania Mainland and Zanzibar). (Accessed 14 January 2011.) Available from http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/2010progressreportssubmittedbycountries/tanzania_2010_country_progress_report_en.pdf.

Ministry of Health and Social Welfare. Tanzania 2010 – National AIDS control Program (NACP). (Accessed 7 February 2011.) Available from http://www.moh.go.tz/NACP.

Tanzania Commission for AIDS (TACAIDS). Report 2010. (Accessed 31 January 2011.) Available from http://www.tacaids.go.tz/component/docman/doc_download/39-newsletter-july-2010.html.

Tanzania Commission for AIDS (TACAIDS). Tanzania national multisectoral strategic framework on HIV and AIDS 2008–2012: costing. (Accessed 23 November 2010.) Available from http://www.tacaids.go.tz/strategic-documents/tanzania-nmsf-2008-2012-aids-strategy-and-action-plan.html.

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