IMPACT OF HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION ON THE OUTCOME OF TREATMENT AND SURVIVAL OF TUBERCULOSIS PATIENTS IN MWANZA, TANZANIA

SETTING: Little is known about the outcome of tuberculosis (TB) treatm ent and subsequent survival of human immunodeficiency virus (HN) infec ted patients treated under routine programme conditions in a developin g country. We followed a cohort of HIV-positive and HIV-negative tuber culosis patients during therapy and assessed their vital and tuberculo sis status 3 years after completion of treatment in Mwanza, Tanzania. METHODS: Newly diagnosed and relapse tuberculosis cases consecutively registered over a 6-month period were enrolled into an epidemiological study of TB/HIV. Treatment outcome was based on information in tuberc ulosis treatment registers. Patients surviving treatment were assessed 3 years later by personal interview Cause of death was determined by verbal autopsy. RESULTS: Of 561 patients enrolled into the study, 505 patients alive at completion of treatment were eligible for assessment at 3 years. Except for mortality, HIV infection was not statistically associated with differing treatment outcomes. At time of follow-up, t he overall mortality was 19% and was associated with HIV infection (ha zard ratio [hr] 3.7, 95% confidence interval [CI] 2.6-5.2) and age 35 years and over (hr 1.5, 95% CI 1.02-2.1), but not with type of tubercu losis, gender, or initial drug resistance. By life table analysis, pro bability of survival at 1 years was 35% for HN-positive patients compa red to 90% for HIV-negative patients. Although no relapse cases were d iagnosed, verbal autopsy suggested equivalent low rates of relapse in both groups. CONCLUSION: These results demonstrate the effectiveness o f the current approach to the treatment of tuberculosis patients regar dless of HIV status. However, HIV-related mortality remains high both during and following completion of treatment, and further studies are needed to determine if this mortality might be reduced by simple inter ventions which are feasible in developing countries.