Tuberculosis case fatality rates in high HIV prevalence populations in sub-Saharan Africa

Background: Tuberculosis is a leading cause worldwide of morbidity and mort ality among HIV-infected people. The HIV era has seen a dramatic increase o f the tuberculosis case fatality rate (CFR) in high HIV prevalence populati ons. Providing care for HIV-infected people must include measures to tackle this high tuberculosis CFR. Aims: To analyse the extent of the increased tuberculosis CFR in high HIV p revalence populations in sub-Saharan Africa, the reasons for this increase and the causes of death, in order to identify possible ways of tackling thi s problem. Methods: References were obtained by searching the MEDLINE on 'tuberculosis ', 'HIV infection', and 'mortality' (MesH or textword). In addition, availa ble data from National Tuberculosis Programme reports were reviewed. Findings: Tuberculosis CFR is closely linked to HIV prevalence. Limited aut opsy data suggest that death from HIV-related diseases other than tuberculo sis is probably the main reason for the increased CFR in HIV-infected tuber culosis patients. Among HIV-infected tuberculosis patients, the higher tube rculosis CFR in sputum smear-negative and extrapulmonary than in sputum sme ar-positive tuberculosis cases can also be attributed to misdiagnosis of HI V-related diseases as tuberculosis. The adverse effect of the HIV/AIDS epid emic on general health service performance probably accounts for the higher tuberculosis CFR among HIV-negative tuberculosis patients in high prevalen ce populations than that in low HIV-prevalence populations. Conclusion: Tackling the problem of the increased tuberculosis CFR in high HIV prevalence populations requires collaboration between tuberculosis cont rol and HIV/ AIDS programmes in implementing measures such as improved heal th services, tuberculosis and HIV control services, preventive treatment fo r HIV-related diseases and anti-HIV treatment. (C) 2001 Lippincott Williams & Wilkins.