02799nas a2200421   4500000000100000008004100001260001600042653001000058653002000068653001900088653001100107653001900118653001100137653004800148653001400196653000900210653001600219653001700235653001700252653001100269100001500280700002200295700001500317700001400332700001300346700001500359700002000374700001400394700001400408700001200422700001800434700002500452245018300477300000900660490000700669520168700676022001402363       2011                            d  c2011 Sep 0110aAdult10aAnti-HIV Agents10aCohort Studies10aFemale10aHIV Infections10aHumans10aImmune Reconstitution Inflammatory Syndrome10aIncidence10aMale10aMiddle Aged10aRisk Factors10aTuberculosis10aUganda1 aWorodria W1 aMassinga-Loembe M1 aMazakpwe D1 aLuzinda K1 aMenten J1 aVan Leth F1 aMayanja-Kizza H1 aKestens L1 aMugerwa R1 aReiss P1 aColebunders R1 aTB-IRIS Study Group 00aIncidence and predictors of mortality and the effect of tuberculosis immune reconstitution inflammatory syndrome in a cohort of TB/HIV patients commencing antiretroviral therapy.  a32-70 v583 a<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>  a1944-7884