Table II.
Data from cohort and observational studies evaluating the impact of antiretroviral therapy (ART) on mortality in HIV-infected tuberculosis patients: 2009-2018
| Main author | Country | Sample size | Impact of ART on mortality |
|---|---|---|---|
| Gadkowski et al19 | North Carolina |
5332 | 5% patients died before initiating TB treatment. Among those who survived, 13.6% died before to completing TB treatment. |
| Velasco et al17 | Spain | 6934 | Treatment was associated with better survival. |
| Varma et al18 | Phuket | 5851 | Mortality during TB treatment occurred in 17%. Factors associated with reduced risk of mortality were ART use, fluconazole use and co-trimoxazole use. |
| van Lettow et al21 | Malawi | 2155 | Early initiation of ART in co-infected patients on TB treatment improved ART guideline uptake. |
| Franke et al20 | Rwanda | 308 | Early ART decreased mortality rates in patients with low CD4+ cell counts and enhanced retention in care, regardless of CD4+ cell count. |
| Worodria et al22 | Uganda | 302 | 68% of the 53 patients died within the first six months of TB infection. |
| Ansa et al38 | Ghana | 1330 | Mortality rates were 18% in all cases and 25% in HIV-related cases after treatment integration. |
| Gupta et al23 | South Africa | 1544 | Mortality rates during the first year of ART were 8.84 deaths/100 person-years decreasing to 1.14 deaths/100 person-years after five years. Mortality risk was greater in the initial six months of ART for those with prevalent TB at baseline (IRR: 2.33) and within six months after diagnoses of incident TB (IRR: 3.8). |
| Sileshi et al24 | Northwest Ethiopia |
422 | 29.3% TB-HIV co-infected patients died in the non-ART cohort compared to 18% who died that were on ART. |
| Shastri et al25 | India | 6480 | Treatment success in co-infected patients not on ART was 54% versus 80% success rates for those on ART. Mortality rates in co-infected patients were two-fold higher than TB only patients. |
| Stockdale et al36 | Kenya | 404 | CD4+ cell counts ≤50 cells/µl had a significant reduction in death in the early group versus the late group. No difference in mortality in CD4 count >50 cells/µl between both. |
| Saraceni et al26 | Rio de Janeiro |
947 | ART started early following treatment in co-infected patients showed 89% decreased risk of death versus delayed ART initiation. |
| Yang et al27 | Taiwan | 229 | Initiating ART in TB treatment showed improved one-year survival. Early start of ART within two months of TB treatment showed no significant difference in survival versus late initiation. |
| Han et al35 | Asia-Pacific Region |
768 | Treatment outcomes and mortality of TB-HIV patients starting ART within three months of TB treatment did not differ significantly from those starting late. Mortality overall was greater among those diagnosed with TB while initiating ART. |
| Kirenga et al28 | Kampala, Uganda |
96 | 34% of HIV-infected patients had a successful outcome after initiating treatment. |
| Nglazi et al34 | South Africa | 797 | Higher mortality in TB-HIV-infected patients not on ART versus HIV-uninfected patients. Increasing age was associated with higher mortality. |
| Bigna et al32 | Cameroon | 99 | Higher death rates in the intensive phase of TB treatment among TB-HIV co-infected patients. |
| Podlekareva et al37 | LA, WE, EE | 1406 | 19% of participants died within 12 months, 188 (71%) of these deaths were TB related, 18% received ART at TB. The proportion of patients who initiated ART prior to TB diagnosis was similar among those who died and stayed alive. |
| Mutembo et al29 | Zambia | 4452 | Of the 257 co-infected patients on ART, 9% died and 8% were lost to follow up. Of the 80 patients not on ART, 25% died and 24% were lost to follow up. Patients on ART had better survival outcomes versus those not treated. |
| Nagu et al30 | Tanzania | 1696 | Mortality risk for TB-HIV patients was reduced when initiating ART after 14 days of TB therapy. Initiation of ART reduced mortality among TB-HIV patients. |
| da Silva Escada et al31 | Brazil | 310 | Mortality rate following the first 30 days of TB treatment start was 44/100 person-years. Death probability in one year from TB treatment start was ~13%. |
| Adamu et al39 | Nigeria | 1424 | 6.6% died after initiating TB treatment with a death rate of 3.68/100 person-years. Most deaths occurred soon after treatment initiation with a death rate of 37.6/100 person-years in the first week of treatment. |
| Kaplan et al33 | South Africa | 60,482 | Patients on ART at the beginning of TB therapy demonstrated greater risk of TB death with increased age. |
LA, Latin America; WE, Western Europe; EE, Eastern Europe; IRR, incidence rate ratio