Background
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.
Methods
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.
Results
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.
Conclusion
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/sfSKwA
By:
Department of Medicine, University of Cape Town
Critical Care Medicine Department, National Institutes of
Health
More at: https://twitter.com/hiv_insight
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