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Randomized Controlled Trial
. 2011 Oct;15(10):1390-6.
doi: 10.5588/ijtld.11.0056.

Risk factors for mortality in smear-negative tuberculosis suspects: a cohort study in Harare, Zimbabwe

P Macpherson  1 , M Dimairo, T Bandason, A Zezai, S S Munyati, A E Butterworth, S Mungofa, S Rusakaniko, K Fielding, P R Mason, E L Corbett
Affiliations
Randomized Controlled Trial

Risk factors for mortality in smear-negative tuberculosis suspects: a cohort study in Harare, Zimbabwe

P Macpherson et al. Int J Tuberc Lung Dis. 2011 Oct.

Abstract

Objective: To investigate mortality rates and risk factors for death among smear-negative tuberculosis (TB) suspects.

Design: Cohort study nested within a cluster-randomised trial of community-based active case finding. Smear-negative TB suspects were followed for 12 months, with home tracing where necessary. We calculated mortality rates and used regression analysis to investigate the relationship between clinical characteristics and death.

Results: Between February 2006 and June 2007, 1195 smear-negative TB suspects were followed for 1136.8 person-years. Human immunodeficiency virus (HIV) prevalence was 63.3%. During follow-up, 139 participants died (11.6%) and mortality rates remained high throughout; 119 (16.5%) HIV-positive individuals and 13 (3.1%) HIV-negative individuals died (HR = 5.8, 95%CI 3.3-10.4, P < 0.001). Advanced immunosuppression was the main risk factor for death among HIV-positive participants, with CD4 count < 50 cells/μ l associated with a 13-fold increased risk of death. Antiretroviral treatment (ART) was initiated by only 106 (14.7%), with long delays in accessing care.

Conclusion: HIV-positive smear-negative TB suspects are at high and sustained risk of death. Current guidelines for the management of HIV-infected TB suspects are limited, and this study adds to evidence that specific policies are required to promote earlier HIV and TB diagnosis and reduce delays in ART initiation.

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Figures

Figure 1
Figure 1
Cohort flow chart. TB = tuberculosis; HIV = human immunodeficiency virus.
Figure 2
Figure 2
Kaplan-Meier plot of mortality of smear-negative tuberculosis suspects stratified by HIV status. HIV− = human immunodeficiency virus negative; HIV+ = human immunodeficiency virus positive.
Figure 3
Figure 3
Mortality rate in HIV-positive participants stratified by CD4 count strata and HIV test. *Participant underwent HIV testing and counselling but did not have CD4 count measured. †Participant underwent anonymous HIV testing for study purposes and did not have CD4 count measured. HTC = HIV testing and counselling; HIV+ = human immunodeficiency virus positive.
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