Table 4.

Implications and Potential Interventions to Reduce Human Immunodeficiency Virus/Tuberculosis Mortality

Issue	Evidence for Association With HIV/TB Mortality	Possible Interventions	Further Research/Unanswered Questions
ART failure	• Higher mortality in ART-experienced patients • Low median CD4 counts and high viral loads in patients taking ART >6 mo	• Rapid screening for virological failure at admission (eg using point-of-care HIV viral load assay) • Adherence interventions or switch to second-line ART • Integrase inhibitors (few drug–drug interactions with TB medication)	• Prevalence of HIV drug resistance • Timing of ART switch in HIV/TB patients failing ART • Optimal regimen for switching
TB during early ART	• One-fifth of HIV/TB patients were within 3 mo of ART initiation • High mortality	• Improved TB screening at ART initiation • Better implementation of TB preventive therapy	• Best approach for TB screening in ART-naive patients (eg TB-LAM, Xpert, and/or chest radiography) • Implementation research for TB preventive therapy
Supportive care and comorbidities	• WHO danger signs and sepsis are common • 10% cryptococcal antigenemia • Life-threatening anemia has high mortality • 28% of deaths after discharge	• Screening, treatment, and/or prophylaxis for coinfection • Improved supportive care • More intensive follow-up postdischarge from hospital	• Prevalence of bacterial coinfection and AMR • Evidence for safety and efficacy of supportive care (eg, IV fluids and/or blood transfusion) • Impact of enhanced follow-up on outcomes, and frequency of visits
Identification of high-risk patients	• Clinical phenotype associated with high mortality • Urine diagnostics associated with higher mortality	• Predictive tools to identify patients at higher risk of mortality who may benefit from interventions (eg, clinical risk score)	• Derivation and validation of prognostic score • Use of score(s) for implementation of interventions aimed at mortality

Abbreviations: AMR, antimicrobial resistance; ART, antiretroviral therapy; HIV, human immunodeficiency virus; IV, intravenous; TB, tuberculosis; TB-LAM, Determine TB-LAM Ag assay; WHO, World Health Organization.