Long-term outcome in patients registered with tuberculosis in Zomba, Malawi: mortality at 7 years according to initial HIV status and type of TB


Kang'Ombe, CT; Harries, AD; Ito, K; Clark, T; Nyirenda, TE; Aldis, W; Nunn, PP; Semba, RD; Salaniponi, FML; (2004) Long-term outcome in patients registered with tuberculosis in Zomba, Malawi: mortality at 7 years according to initial HIV status and type of TB. The international journal of tuberculosis and lung disease, 8 (7). pp. 829-36. ISSN 1027-3719

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Abstract

SETTING: Zomba Central Hospital, Malawi. OBJECTIVES: To determine the outcome of all adult patients who were registered for tuberculosis (TB) treatment 7 years previously according to initial human immunodeficiency virus (HIV) status and type of TB. DESIGN: A retrospective cohort study of adult patients registered for TB treatment between July and December 1995. Follow-up at patients' homes was performed at the end of treatment, at 32 months and at 84 months (7 years) from the time of TB registration. FINDINGS: Eight hundred and twenty-seven TB patients were registered: 793 had concordant HIV test results, of whom 612 (77%) were HIV-positive. At 7 years, 136 (17%) patients were alive, 539 (65%) had died and 152 (18%) were lost to follow-up. The death rate for all TB patients was 23.7 per 100 person-years of observation. HIV-positive patients had higher death rates than HIV-negative patients (hazard ratio [HR] 2.2, 95% confidence interval [95%CI] 1.7-2.8). Death rates in smear-negative pulmonary TB patients (HR 2.1, 95%CI 1.7-2.6) and in patients with extra-pulmonary TB (HR 1.7, 95% CI 1.3-2.0) were higher than in patients with smear-positive PTB. CONCLUSIONS: There was a high mortality rate in TB patients during and after anti-tuberculosis treatment. Adjunctive treatments to reduce death rates are urgently needed.

Item Type: Article
Keywords: Adult, Antitubercular Agents, Female, Follow-Up Studies, HIV Infections, Humans, Malawi, Male, Middle Aged, Sputum, Survival Analysis, Treatment Outcome, Tuberculosis, Pulmonary, Adult, Antitubercular Agents, therapeutic use, Female, Follow-Up Studies, HIV Infections, complications, Humans, Malawi, Male, Middle Aged, Sputum, cytology, Survival Analysis, Treatment Outcome, Tuberculosis, Pulmonary, drug therapy, mortality, virology
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 15260273
Web of Science ID: 222630000005
URI: http://researchonline.lshtm.ac.uk/id/eprint/8934

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