Early Mortality Among Patients with Hiv-Associated Tuberculosis in Africa: Implications for the Time to Initiation of Antiretroviral Treatment (Abstracts: CRO1 2007) (Report‪)‬

The HIV epidemic has been associated with major increases in tuberculosis (TB) notification rates in South African townships over the past 10 years, principally among young adults. (1) Not surprisingly, as antiretroviral treatment (ART) clinics have been established in these communities, TB has emerged as a key challenge. The burden of TB within ART clinics is very high. We have previously reported from an ART service in Gugulethu, Cape Town, that among patients enrolling in the clinic, 52% have previously been treated for one or more episodes of TB, 26% have an active diagnosis of TB and a further 10% develop TB during the first year of ART. (2) Overall, during the first year from enrolment, approximately one-third of patients receive concurrent antituberculosis treatment and ART. The impact of this huge burden of TB within ART services in sub-Saharan Africa has not been fully characterised, but it might be expected to contribute to the high early mortality in programmes in the region. (3) Indeed, we have previously reported from the clinic in Gugulethu that patients who have TB at entry to the programme have a 2-fold greater mortality risk in the first year of ART compared with those who remain TB-free. (2) While not altogether surprising, this observation nevertheless warrants careful examination to gain a better understanding of the factors contributing to this high early mortality as some deaths may be preventable.