BACKGROUND: We describe the presentation and outcome of care among patients with tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection from a prospective observational cohort in Uganda. METHODS: We analysed basic demographics, CD4+ counts, time of initiating antiretroviral therapy (ART), clinical and haematological parameters and outcome of care of 386 patients enrolled between February 2007 and March 2010. RESULTS: At presentation, 56.7% of the patients were sputum-positive, 89.9% had new TB infection, 62.7% had wasting, 78.7% were anaemic, 72.1% had a CD4+ count of <200 cells/mm(3), 20.2% had pneumonia, 50.3% had oral thrush and 1.3% had Kaposi's sarcoma. Patients developing TB within 3 months of starting ART were less likely to have wasting, to be anaemic or to have a CD4+ count of <100 cells/mm(3). The cure, default and death rates were respectively 54.3%, 24% and 16%. At 8 months, 53 (13.7%) were confirmed dead, 119 (30.8%) were lost to follow-up, 28 (7.3%) were transferred out and 1 (0.3%) had treatment failure. Mortality and loss to follow-up were associated with failure to start ART and having a CD4+ count of <200 cells/mm(3). CONCLUSION: In Uganda, TB-HIV patients present with severe immune suppression and are at increased risk of death and loss to follow-up, particularly those not on ART. There is need for early identification and improved follow-up of TB-HIV co-infected patients.
BACKGROUND: We describe the presentation and outcome of care among patients with tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection from a prospective observational cohort in Uganda. METHODS: We analysed basic demographics, CD4+ counts, time of initiating antiretroviral therapy (ART), clinical and haematological parameters and outcome of care of 386 patients enrolled between February 2007 and March 2010. RESULTS: At presentation, 56.7% of the patients were sputum-positive, 89.9% had new TB infection, 62.7% had wasting, 78.7% were anaemic, 72.1% had a CD4+ count of <200 cells/mm(3), 20.2% had pneumonia, 50.3% had oral thrush and 1.3% had Kaposi's sarcoma. Patients developing TB within 3 months of starting ART were less likely to have wasting, to be anaemic or to have a CD4+ count of <100 cells/mm(3). The cure, default and death rates were respectively 54.3%, 24% and 16%. At 8 months, 53 (13.7%) were confirmed dead, 119 (30.8%) were lost to follow-up, 28 (7.3%) were transferred out and 1 (0.3%) had treatment failure. Mortality and loss to follow-up were associated with failure to start ART and having a CD4+ count of <200 cells/mm(3). CONCLUSION: In Uganda, TB-HIVpatients present with severe immune suppression and are at increased risk of death and loss to follow-up, particularly those not on ART. There is need for early identification and improved follow-up of TB-HIV co-infectedpatients.
Authors: Lincoln Pac; Mara Murray Horwitz; Anne Marion Namutebi; Brandon J Auerbach; Aggrey Semeere; Teddy Namulema; Miriam Schwarz; Robert Bbosa; Allan Muruta; David B Meya; Yukari C Manabe Journal: J Acquir Immune Defic Syndr Date: 2015-04-15 Impact factor: 3.731
Authors: Elizabeth A Reddy; Boniface N Njau; Susan C Morpeth; Kathryn E Lancaster; Alison C Tribble; Venance P Maro; Levina J Msuya; Anne B Morrissey; Gibson S Kibiki; Nathan M Thielman; Coleen K Cunningham; Werner Schimana; John F Shao; Shein-Chung Chow; Jason E Stout; John A Crump; John A Bartlett; Carol D Hamilton Journal: BMC Infect Dis Date: 2014-02-20 Impact factor: 3.090
Authors: Anna Odone; Silvia Amadasi; Richard G White; Theodore Cohen; Alison D Grant; Rein M G J Houben Journal: PLoS One Date: 2014-11-12 Impact factor: 3.240