EARLY MORTALITY AMONG PATIENTS WITH HIV-ASSOCIATED TB IN AFRICA: IMPLICATIONS FOR THE TIME TO INITIATE ART

RESULTS: The mortality rate among those with TB was 1.82-fold (95%CI 1.62 to 2.80) greater than that of patients who remained TB-free (39.7 vs 21.7 deaths/100 person-years; p = 0.003). However, multivariate analysis revealed that mortality in the overall cohort was not independently associated with TB but was only associated with CD4 count <100 cells/µL (AHR = 2.85, 95%CI 1.52 to 5.34) and baseline WHO stage 4 disease (AIDS) (AHR = 2.94, 95%CI 1.80 to 4.82). Of patients with TB diagnosed within the program but before ART initiation (n = 73), 48 had received ART by data censorship after a median of 42 days (IQR 28 to 67) from TB diagnosis. A total of 14 deaths occurred of which 10 (71%) were among patients waiting to commence ART and most (n = 7) were within the first 4 weeks of anti-TB treatment. Just 4 deaths occurred after initiation of ART of which 2 were due to immune reconstitution disease. Risk of death was not associated with baseline patient or disease characteristics but only ART status.