Abstract
Despite the impressive global results of DOTS in India, the effectiveness of DOTS for the treatment of tuberculosis in HIV-infected patients is not well known. This is an observational prospective cohort study performed in Anantapur District, Andhra Pradesh, India. The study included 1000 DOTS antituberculosis treatment (ATT) episodes and 840 person-years. CD4 lymphocyte count was below 200 cells/mm3 in 77% of the cases, and 21% were retreatments. Two thirds were presented with extrapulmonary tuberculosis, and the most common form of extrapulmonary tuberculosis was tuberculous meningitis followed by pleuritis, abdominal tuberculosis, and lymphadenitis. Cumulative incidence of mortality was 16%, 26%, 39%, and 46% at 1, 3, 12, and 24 months, respectively. Factors associated with three-month (early) mortality were being homeless, having low CD4+ lymphocyte count, having tuberculous meningitis, belonging to a socially disadvantaged community, having more than 35 years, and being on an antiretroviral therapy at the moment of initiating the ATT. Factors associated with delayed mortality were having low CD4+ lymphocyte count, belonging to a socially disadvantaged community, receiving a category II ATT because of a previous episode of ATT and having acid fast bacilli in sputum before the ATT initiation. These findings indicate that there is an urgent need to improve the treatment of tuberculosis in HIV-infected patients in India.
Highlights
Tuberculosis is a major public health problem worldwide
This study describes the high mortality of HIV-infected patients who received antituberculosis treatment (ATT) under direct observed treatment short-course (DOTS) strategy in this district of India
The results of this study show the high mortality of HIV-infected patients treated of tuberculosis under DOTS in this area of India, confirming what was observed in previous studies from other parts of India
Summary
Tuberculosis is a major public health problem worldwide. With an incidence of 2.3 million cases, India has the highest burden of tuberculosis in the world, and one out of every four cases of tuberculosis worldwide occurred in India in 2010 [1]. India is the third country in the world in terms of number of people infected by HIV, and 9% of patients with tuberculosis who are tested of HIV are HIV-infected [1, 2]. HIV and tuberculosis form a deadly synergy. Latent tuberculosis is common in developing countries, and the immunodeficiency produced by HIV increases the risk of developing active tuberculosis infection [3]. Patients with HIV infection have higher risk of extrapulmonary tuberculosis, tuberculosis relapse, and death than non-HIV-infected patients [4]
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