THE IMPACT OF HUMAN-IMMUNODEFICIENCY-VIRUS ON MORTALITY OF PATIENTS TREATED FOR TUBERCULOSIS IN A COHORT STUDY IN ZAMBIA

We have examined the impact of human immunodeficiency virus (HIV) on m ortality of patients treated for tuberculosis in a prospective study i n Lusaka, Zambia. Patients with sputum smear-positive, miliary, or men ingeal tuberculosis were prescribed 2 months' daily streptomycin, thia cetazone, isoniazid, rifampicin, and pyrazinamide followed by 6 months thiacetazone and isoniazid; others, 2 months streptomycin, thiacetazo ne and isoniazid followed by 10 months thiacetazone and isoniazid. 239 patients (65 HIV-negative and 174 HIV-positive) were followed to 2 ye ars from start of treatment. The crude mortality rate ratio for HIV-po sitive compared with HIV-negative patients over 2 years was 5.00 (95% confidence interval 2.30-10.86). Median survival for HIV-positive pati ents from the start of treatment was 22 months. At least 34% of HIV-po sitive patients for whom cause of death was known died from tuberculos is, three-quarters of these during the first month of treatment. Risk factors for death in HIV-positive patients included multi-site tubercu losis, history of prolonged diarrhoea or fever, oral thrush, splenomeg aly, anergy to tuberculin, low weight, anaemia or lymphopenia, and poo r compliance with regimens containing rifampicin and pyrazinamide. Tub erculosis, even treated, was a major cause of death in patients with H IV infection.