BACKGROUND: In 2007, WHO released revised recommendations and an algorithm for the diagnosis and treatment of smear-negative pulmonary tuberculosis in seriously ill people living with HIV/AIDS. We aimed to assess the effect of the recommendations on clinical outcome in patients in South Africa. METHODS: We enrolled seriously ill patients (aged ≥15 years) with HIV infection and suspected smear-negative pulmonary tuberculosis from three hospitals in KwaZulu-Natal, South Africa. Patients were consecutively enrolled into two cohorts: the first cohort was managed according to standard practice, and the second according to the WHO-recommended algorithm. The primary endpoints were rates of continued stay in hospital at 7 days after admission and survival at 8 weeks after admission. FINDINGS: 338 patients were enrolled in the standard practice cohort between August, 2008, and February, 2009, and 187 were enrolled in the algorithm cohort between March, 2009, and December, 2009. 7 days after hospital admission, 27% (n=50) of patients in the algorithm cohort were still in hospital, compared with 38% (n=130) in the standard practice cohort (rate ratio 0·70, 95% CI 0·53-0·91; p=0·009). 8 weeks after admission, 83% (n=156) of patients in the algorithm cohort were alive, compared with 68% (n=230) in the standard practice cohort (1·23, 1·11-1·35; p=0·0001), with effect modified by hospital location. INTERPRETATION: In seriously ill patients with HIV infection and suspected smear-negative pulmonary tuberculosis, early antituberculosis treatment according to the WHO algorithm could significantly reduce mortality in South Africa. FUNDING: US President's Emergency Plan for AIDS Relief.
BACKGROUND: In 2007, WHO released revised recommendations and an algorithm for the diagnosis and treatment of smear-negative pulmonary tuberculosis in seriously ill people living with HIV/AIDS. We aimed to assess the effect of the recommendations on clinical outcome in patients in South Africa. METHODS: We enrolled seriously ill patients (aged ≥15 years) with HIV infection and suspected smear-negative pulmonary tuberculosis from three hospitals in KwaZulu-Natal, South Africa. Patients were consecutively enrolled into two cohorts: the first cohort was managed according to standard practice, and the second according to the WHO-recommended algorithm. The primary endpoints were rates of continued stay in hospital at 7 days after admission and survival at 8 weeks after admission. FINDINGS: 338 patients were enrolled in the standard practice cohort between August, 2008, and February, 2009, and 187 were enrolled in the algorithm cohort between March, 2009, and December, 2009. 7 days after hospital admission, 27% (n=50) of patients in the algorithm cohort were still in hospital, compared with 38% (n=130) in the standard practice cohort (rate ratio 0·70, 95% CI 0·53-0·91; p=0·009). 8 weeks after admission, 83% (n=156) of patients in the algorithm cohort were alive, compared with 68% (n=230) in the standard practice cohort (1·23, 1·11-1·35; p=0·0001), with effect modified by hospital location. INTERPRETATION: In seriously ill patients with HIV infection and suspected smear-negative pulmonary tuberculosis, early antituberculosis treatment according to the WHO algorithm could significantly reduce mortality in South Africa. FUNDING: US President's Emergency Plan for AIDS Relief.
Authors: Winceslaus Katagira; Nicholas D Walter; Saskia Den Boon; Nelson Kalema; Irene Ayakaka; Eric Vittinghoff; William Worodria; Adithya Cattamanchi; Laurence Huang; John Lucian Davis Journal: J Acquir Immune Defic Syndr Date: 2016-07-01 Impact factor: 3.731
Authors: Jonathan G Peter; Grant Theron; Richard van Zyl-Smit; Asheen Haripersad; Lynelle Mottay; Sarah Kraus; Anke Binder; Richard Meldau; Anneli Hardy; Keertan Dheda Journal: Eur Respir J Date: 2012-02-23 Impact factor: 16.671
Authors: Rulan Griesel; Annemie Stewart; Helen van der Plas; Welile Sikhondze; Molebogeng X Rangaka; Mark P Nicol; Andre P Kengne; Marc Mendelson; Gary Maartens Journal: Clin Infect Dis Date: 2018-04-17 Impact factor: 9.079
Authors: Stephen D Lawn; Anthony D Harries; Graeme Meintjes; Haileyesus Getahun; Diane V Havlir; Robin Wood Journal: AIDS Date: 2012-11-13 Impact factor: 4.177
Authors: M J Cummings; E Goldberg; S Mwaka; O Kabajaasi; E Vittinghoff; A Katamba; A Cattamanchi; N Kenya-Mugisha; J L Davis; S T Jacob Journal: Public Health Action Date: 2017-11-13