Independent Predictors of Tuberculosis Mortality in a High HIV Prevalence Setting: A Retrospective Cohort Study

Identifying those at increased risk of death during TB treatment is a priority in resource-constrained settings. We performed this study to determine predictors of mortality during TB treatment.

We performed a retrospective analysis of a TB surveillance population in a high HIV prevalence area that was recorded in ETR.net (Electronic Tuberculosis Register). Adult TB cases initiated TB treatment from 2007 through 2009 in Khayelitsha, South Africa. Cox proportional hazards models were used to identify risk factors for death (after multiple imputations for missing data). Model selection was performed using Akaike’s Information Criterion to obtain the most relevant predictors of death.

Of 16,209 adult TB cases, 851 (5.3 %) died during TB treatment. In all TB cases, advancing age, co-infection with HIV, a prior history of TB and the presence of both pulmonary and extra-pulmonary TB were independently associated with an increasing hazard of death. In HIV-infected TB cases, advancing age and female gender were independently associated with an increasing hazard of death. Increasing CD4 counts and antiretroviral treatment during TB treatment were protective against death. In HIV-uninfected TB cases, advancing age was independently associated with death, whereas smear-positive disease was protective.

We identified several independent predictors of death during TB treatment in resource-constrained settings. Our findings inform resource-constrained settings about certain subgroups of TB patients that should be targeted to improve mortality during TB treatment.

Below:  Kaplan Meier plot showing cumulative mortality during TB treatment: (1) overall mortality, and (2) mortality by HIV status

Full article at: http://goo.gl/tt4txn

By: Dominique J. Pepper¹², Michael Schomaker³, Robert J. Wilkinson¹⁴⁵, Virginia de Azevedo⁶ and Gary Maartens^17*

¹Department of Medicine, University of Cape Town, Anzio Road, Cape Town 7925, South Africa

²Critical Care Medicine Department, National Institutes of Health, 10 Center Drive, Bethesda, USA

³Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Anzio Road, Cape Town 7925, South Africa

⁴Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa

⁵Department of Medicine, Imperial College, London W2 1PG, UK

⁶City Health, Cape Town, South Africa

⁷Division of Pharmacology, Groote Schuur Hospital, Anzio Road, Cape Town 7925, South Africa

  

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