@article{22116,
  keywords = {Adult, Anti-HIV Agents, Cohort Studies, Female, HIV Infections, Humans, Immune Reconstitution Inflammatory Syndrome, Incidence, Male, Middle Aged, Risk Factors, Tuberculosis, Uganda},
  author = {Worodria W and Massinga-Loembe M and Mazakpwe D and Luzinda K and Menten J and Van Leth F and Mayanja-Kizza H and Kestens L and Mugerwa R and Reiss P and Colebunders R and TB-IRIS Study Group },
  title = {Incidence and predictors of mortality and the effect of tuberculosis immune reconstitution inflammatory syndrome in a cohort of TB/HIV patients commencing antiretroviral therapy.},
  abstract = {<p><b>BACKGROUND: </b>Tuberculosis-HIV (TB-HIV) coinfection remains an important cause of mortality in antiretroviral therapy (ART) programs. In a cohort of TB-HIV-coinfected patients starting ART, we examined the incidence and predictors of early mortality.</p><p><b>METHODS: </b>Consecutive TB-HIV-coinfected patients eligible for ART were enrolled in a cohort study at the Mulago National Tuberculosis and Leprosy Program clinic in Kampala, Uganda. Predictors of mortality were assessed using Cox proportional hazards analysis.</p><p><b>RESULTS: </b>Three hundred and two patients [median CD4 count 53 cells/μL (interquartile range, 20-134)] were enrolled. Fifty-three patients died, 36 (68%) of these died within the first 6 months of TB diagnosis. Male sex [hazard (HR): 2.19; 95% confidence interval (CI): 1.19 to 4.03; P = 0.011], anergy to tuberculin skin test [HR: 2.59 (1.10 to 6.12); P = 0.030], a positive serum cryptococcal antigen result at enrollment (HR: 4.27; 95% CI: 1.50 to 12.13; P = 0.006) and no ART use (HR: 4.63; 95% CI: 2. 37 to 9.03; P < 0.001) were independent predictors of mortality by multivariate analysis. Six (10%) patients with TB immune reconstitution inflammatory syndrome died, and in most, an alternative contributing cause of death was identified.</p><p><b>CONCLUSIONS: </b>Mortality among these TB-HIV-coinfected patients was high particularly when presenting with advanced HIV disease and not starting ART, reinforcing the need for timely and joint treatment for both infections. Screening for a concomitant cryptococcal infection and antifungal treatment for patients with cryptococcal antigenemia may further improve clinical outcome.</p>},
  year = {2011},
  journal = {Journal of acquired immune deficiency syndromes (1999)},
  volume = {58},
  pages = {32-7},
  month = {2011 Sep 01},
  issn = {1944-7884},
  doi = {10.1097/QAI.0b013e3182255dc2},
  language = {eng},
}