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Chest Infections |

Predictors of Tuberculosis Mortality in a High HIV Prevalent Setting

Dominique Pepper*, MD; Imran Sunesara, BS; Wanmei Wang, BS; Feriyl Bhaijee, MBChB; Robert Wilkinson, MD; Virginia DeAzevedo, MD; Risa Webb, MD; Mike Griswold, PhD; Gary Maartens, MD
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University of Mississippi Medical Center, Jackson, MS


Chest. 2012;142(4_MeetingAbstracts):210A. doi:10.1378/chest.1377853
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Abstract

SESSION TYPE: Respiratory Infections Posters I

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Tuberculosis (TB) is the leading infectious cause of death worldwide among those infected with HIV. Strategies to reduce TB-related mortality are urgently needed. Our objective was to identify and predict groups of TB patients at increased risk of death.

METHODS: Design, Setting and Patients. The Electronic Tuberculosis Register (ETR.net) includes all patients with tuberculosis in Khayelitsha, South Africa. All TB patients who initiated TB treatment from 2007 through 2009 were included in this study. We organized TB patients by gender, HIV status, and degree of immune suppression into the following groups: HIV uninfected (Male/Female: 2,409/1,525), HIV-infected with a CD4 count > 350 cells/microL (M/F: 1,665/2,253), and HIV-infected with a CD4 count < 350 cells/microL (M/F: 1,901/2,292). Main Outcome Measures. For each group, we calculated age-specific TB mortality proportions, determined adjusted odds ratios (aOR) for death, and performed logistic regression. We also created Cox-proportional hazard models to determine hazard ratios (HR) for death during TB treatment.

RESULTS: Of 12,045 TB patients, 864 (7%) died during TB treatment. Increasing age (aHR=1.6, 95%CI: 1.51-1.76) and advancing degree of immune-suppression (aHR=1.5, 95%CI: 1.33-1.64) were significantly associated with an increasing hazard of death, while gender was not (aHR=1.0, 95%CI: 0.84-1.22). All HIV-infected patients of 15 years age or older were at increased risk of death (aOR=2.3, 95%CI: 1.95 - 2.79). Among TB patients of 55 years age or older, HIV-infected women were more likely to die than HIV-infected men (aOR=3.7, 95%CI: 1.83 - 7.34), while HIV uninfected men were more likely to die than HIV uninfected women (aOR=1.9, 95%CI: 1.01 - 3.43).

CONCLUSIONS: We identified an association between TB-related mortality and age, which is independent of HIV status or degree of immune-suppression.

CLINICAL IMPLICATIONS: Among TB patients of 55 years age or older, interventions should be prioritized to reduce death among HIV-infected women and HIV uninfected men. Our findings also add impetus to current WHO and CDC guidelines that ART be initiated among all HIV-infected adults with active tuberculosis, irrespective of CD4 cell count.

DISCLOSURE: The following authors have nothing to disclose: Dominique Pepper, Imran Sunesara, Wanmei Wang, Feriyl Bhaijee, Robert Wilkinson, Virginia DeAzevedo, Risa Webb, Mike Griswold, Gary Maartens

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University of Mississippi Medical Center, Jackson, MS

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