Risk factors for mortality among HIV―positive patients with and without active tuberculosis in Dar es Salaam, Tanzania

• Published in: Antiviral therapy 2012-01, Vol.17 (2), p.265-274
• Main Authors: MUGUSI, Sabina F, NGAIMISI, Eliford, JANABI, Mohamed Y, MUGUSI, Ferdinand M, MINZI, Omary Ms, SASI, Philip G, BAKARI, Muhammad, LINDQUIST, Lars, AKLILLU, Eleni, SANDSTROM, Eric G
• Format: Article
• Language: English
• Subjects: Adult; AIDS-Related Opportunistic Infections - mortality; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active; Antiviral agents; Bacterial diseases; Benzoxazines - therapeutic use; Biological and medical sciences; Candidiasis, Oral - complications; Candidiasis, Oral - mortality; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Cohort Studies; Coinfection; Female; HIV Infections - complications; HIV Infections - mortality; HIV Infections - pathology; Human bacterial diseases; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Karnofsky Performance Status; Leukocyte Count; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Pharmacology. Drug treatments; Risk Factors; Sarcoma, Kaposi - complications; Sarcoma, Kaposi - mortality; Tanzania; Tuberculosis - complications; Tuberculosis - mortality; Tuberculosis - pathology; Tuberculosis and atypical mycobacterial infections; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 1359-6535; 2040-2058; 2040-2058
• DOI: 10.3851/IMP1956

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. A cohort of HIV-infected patients with CD4(+) T-cell counts of ≤200 cells/μl 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. 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. 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.