High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up

Abstract

There is little information about long-term follow-up in patients with smear-negative pulmonary tuberculosis (PTB) or extrapulmonary tuberculosis (EPTB) who have been treated under routine programme conditions in sub-Saharan Africa. A prospective study was carried out to determine outcome 32 months from start of treatment in an unselected cohort of 827 adults TB inpatients registered at Zomba Hospital, Malawi, in 1 July-31 December 1995. By 32 months, 351 (42%) patients had died. Death rates were 30% (95% confidence interval [95% CI] 25-35%) in 386 patients with smear-positive PTB, 60% (95% CI 53-67%) in 211 patients with smear-negative PTB and 47% (95% CI 40-54%) in 230 patients with EPTB. Of the 793 patients with concordant HIV test results 612 (77%) were HIV seropositive: 47% HIV-positive patients were dead by 32 months compared with 27% HIV-negative patients (adjusted hazard ratio [HR] 2.3; 95% CI 1.7-3.1, P < 0.001). Smear-negative PTB patients had the highest death rates during the 32-month follow-up (HR 2.7; 95% CI 2.1-3.5, P < 0.001 compared to smear-positive patients), followed by EPTB patients (HR 1.9; 95% CI 1.5-2.5, P < 0.001 compared to smear-positive patients). When analysis was restricted to after the treatment period had finished (i.e., months 12-32), the differences in mortality were maintained for HIV-serostatus and for types of TB. Low-cost, easy to implement strategies for reducing mortality in HIV-positive TB patients in sub-Saharan Africa (such as the use of trimethoprim-sulphamethoxazole prophylaxis) need to be tested urgently in programme settings.

Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil

“…Some measures recommended by the WHO 28 could be implemented in this area, such as joint planning of some TB/HIV activities, periodic surveillance of HIV among TB patients, HIV counseling, and a rational regimen of treatment and follow-up for co-infected patients. The association with death during treatment in this setting is similar to other studies 29,30 .…”

Clinical Predictors for Death in HIV-positive and HIV-negative Tuberculosis Patients in Guinea-Bissau

“…One confounding factor is that HIV-positive patients present with smear-negative tuberculosis to a significantly higher degree [28][29][30]. However, several of the papers showing increased mortality in smear-negative patients have adjusted for HIV infection [22,24,25,27]. In our study, we found that HIV-positive patients were more likely to be smear negative than HIV-negative patients (OR = 1.77, 95% CI 1.…”

“…Although some later studies agree with these early findings [20,21], there are several recent studies that indicate a worse survival in smearnegative pulmonary tuberculosis patients [17,[22][23][24][25][26] and patients with extra-pulmonary tuberculosis [24,25,27]. One confounding factor is that HIV-positive patients present with smear-negative tuberculosis to a significantly higher degree [28][29][30].…”

Desfecho do tratamento e confirmação laboratorial do diagnóstico de tuberculose em pacientes com HIV/AIDS no Recife, Pernambuco, Brasil

“…(6) The few such studies that have been conducted have provided discrepant results. One study, (7) involving patients with extrapulmonary TB and co-infected with HIV, revealed that, in patients without diagnostic confirmation of TB, the mortality rate was four times greater than in those with confirmed diagnosis.…”