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Open Access Highly Access Research article

Factors associated with mortality in HIV-infected and uninfected patients with pulmonary tuberculosis

Ferdinand M Mugusi1*, Saurabh Mehta2, Eduardo Villamor2, Willy Urassa3, Elmar Saathoff4, Ronald J Bosch5 and Wafaie W Fawzi2,5

Author Affiliations

1 Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

2 Department of Nutrition, Harvard School of Public Health, Boston, USA

3 Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

4 University of Munich, Munich, Germany

5 Department of Biostatistics (RJB) and Global Health and Population (WWF), Harvard School of Public Health, Boston, USA

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BMC Public Health 2009, 9:409 doi:10.1186/1471-2458-9-409

Published: 12 November 2009

Abstract

Background

HIV has fuelled the TB epidemic in sub-Saharan Africa. Mortality in patients co-infected with TB and HIV is high. Managing factors influencing mortality in TB patients might help reducing it. This study investigates factors associated with mortality including patients' HIV sero-status, CD4 cell count, laboratory, nutritional and demographic characteristics in AFB smear positive pulmonary TB patients.

Methods

We studied 887 sputum smear positive PTB patients, between 18 and 65 years of age receiving standard 8 months anti-TB treatment. Demographic, anthropometric and laboratory data including HIV, CD4 and other tests were collected at baseline and at regular intervals. Patients were followed for a median period of 2.5 years.

Results

Of the 887 participants, 155 (17.5%) died, of whom 90.3% (140/155) were HIV-infected, a fatality of 29.7% (140/471) compared to 3.6% (15/416) among HIV-uninfected. HIV infection, age, low Karnofsky score, CD4 cell counts and hemoglobin, high viral load, and oral thrush were significantly associated with high mortality in all patients.

Conclusion

Mortality among HIV-infected TB patients is high despite the use of effective anti-TB therapy. Most deaths occur after successful completion of therapy, an indication that patients die from causes other than TB. HIV infection is the strongest independent predictor of mortality in this cohort.