High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up
Identifieur interne : 005263 ( Istex/Corpus ); précédent : 005262; suivant : 005264High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up
Auteurs : C. Kang'Ombe ; A. D. Harries ; H. Banda ; D. S. Nyangulu ; C. J. M. Whitty ; F. M. L. Salaniponi ; D. Maher ; P. NunnSource :
- Transactions of The Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 2000-05.
English descriptors
- KwdEn :
Abstract
There is little information about long-term follow-up in patients with smear-negative pulmonary tuberculosis (PTB) or extrapulmonary tuberculosis (EPTB) who have been treated under routine programme conditions in sub-Saharan Africa. A prospective study was carried out to determine outcome 32 months from start of treatment in an unselected cohort of 827 adult TB inpatients registered at Zomba Hospital, Malawi, in 1 July–31 December 1995. By 32 months, 351 (42%) patients had died. Death rates were 30% (95% confidence interval [95% CI] 25–35%) in 386 patients with smear-positive PTB, 60% (95% CI 53–67%) in 211 patients with smear-negative PTB and 47% (95% CI 40–54%) in 230 patients with EPTB. Of the 793 patients with concordant HIV test results 612 (77%) were HIV seropositive: 47% HIV-positive patients were dead by 32 months compared with 27% HIV-negative patients (adjusted hazard ratio [HR] 2·3; 95% CI 1·7-3·1, P < 0·001). Smear-negative PTB patients had the highest death rates during the 32-month follow-up (HR 2·7; 95% CI 2·1–3·5, P < 0·001 compared to smear-positive patients), followed by EPTB patients (HR 1·9; 95% CI 1·5-2·5, P < 0·001 compared to smear-positive patients). When analysis was restricted to after the treatment period had finished (i.e., months 12–32), the differences in mortality were maintained for HIV-serostatus and for types of TB. Low-cost, easy to implement strategies for reducing mortality in HIV-positive TB patients in sub-Saharan Africa (such as the use of trimethoprim-sulphamethoxazole prophylaxis) need to be tested urgently in programme settings.
Url:
DOI: 10.1016/S0035-9203(00)90335-3
Links to Exploration step
ISTEX:FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up</title><author><name sortKey="Kang Ombe, C" sort="Kang Ombe, C" uniqKey="Kang Ombe C" first="C." last="Kang'Ombe">C. Kang'Ombe</name><affiliation><mods:affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Harries, A D" sort="Harries, A D" uniqKey="Harries A" first="A. D." last="Harries">A. D. Harries</name><affiliation><mods:affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</mods:affiliation></affiliation><affiliation><mods:affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: c-cruz@dfid.gtnet.gov.uk</mods:affiliation></affiliation><affiliation><mods:affiliation></mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: c-cruz@dfid.gtnet.gov.uk</mods:affiliation></affiliation></author><author><name sortKey="Banda, H" sort="Banda, H" uniqKey="Banda H" first="H." last="Banda">H. Banda</name><affiliation><mods:affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Nyangulu, D S" sort="Nyangulu, D S" uniqKey="Nyangulu D" first="D. S." last="Nyangulu">D. S. Nyangulu</name><affiliation><mods:affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Whitty, C J M" sort="Whitty, C J M" uniqKey="Whitty C" first="C. J. M." last="Whitty">C. J. M. Whitty</name><affiliation><mods:affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK</mods:affiliation></affiliation></author><author><name sortKey="Salaniponi, F M L" sort="Salaniponi, F M L" uniqKey="Salaniponi F" first="F. M. L." last="Salaniponi">F. M. L. Salaniponi</name><affiliation><mods:affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Maher, D" sort="Maher, D" uniqKey="Maher D" first="D." last="Maher">D. Maher</name><affiliation><mods:affiliation>Global Tuberculosis Programme, World Health Organization, CH-1211 Geneva 27, Switzerland</mods:affiliation></affiliation></author><author><name sortKey="Nunn, P" sort="Nunn, P" uniqKey="Nunn P" first="P." last="Nunn">P. Nunn</name><affiliation><mods:affiliation>Global Tuberculosis Programme, World Health Organization, CH-1211 Geneva 27, Switzerland</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1</idno><date when="2000" year="2000">2000</date><idno type="doi">10.1016/S0035-9203(00)90335-3</idno><idno type="url">https://api.istex.fr/document/FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">005263</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">005263</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up</title><author><name sortKey="Kang Ombe, C" sort="Kang Ombe, C" uniqKey="Kang Ombe C" first="C." last="Kang'Ombe">C. Kang'Ombe</name><affiliation><mods:affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Harries, A D" sort="Harries, A D" uniqKey="Harries A" first="A. D." last="Harries">A. D. Harries</name><affiliation><mods:affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</mods:affiliation></affiliation><affiliation><mods:affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: c-cruz@dfid.gtnet.gov.uk</mods:affiliation></affiliation><affiliation><mods:affiliation></mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: c-cruz@dfid.gtnet.gov.uk</mods:affiliation></affiliation></author><author><name sortKey="Banda, H" sort="Banda, H" uniqKey="Banda H" first="H." last="Banda">H. Banda</name><affiliation><mods:affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Nyangulu, D S" sort="Nyangulu, D S" uniqKey="Nyangulu D" first="D. S." last="Nyangulu">D. S. Nyangulu</name><affiliation><mods:affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Whitty, C J M" sort="Whitty, C J M" uniqKey="Whitty C" first="C. J. M." last="Whitty">C. J. M. Whitty</name><affiliation><mods:affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK</mods:affiliation></affiliation></author><author><name sortKey="Salaniponi, F M L" sort="Salaniponi, F M L" uniqKey="Salaniponi F" first="F. M. L." last="Salaniponi">F. M. L. Salaniponi</name><affiliation><mods:affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Maher, D" sort="Maher, D" uniqKey="Maher D" first="D." last="Maher">D. Maher</name><affiliation><mods:affiliation>Global Tuberculosis Programme, World Health Organization, CH-1211 Geneva 27, Switzerland</mods:affiliation></affiliation></author><author><name sortKey="Nunn, P" sort="Nunn, P" uniqKey="Nunn P" first="P." last="Nunn">P. Nunn</name><affiliation><mods:affiliation>Global Tuberculosis Programme, World Health Organization, CH-1211 Geneva 27, Switzerland</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Transactions of The Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbrev">Trans R Soc Trop Med Hyg</title><idno type="ISSN">0035-9203</idno><idno type="eISSN">1878-3503</idno><imprint><publisher>Royal Society of Tropical Medicine and Hygiene</publisher><date type="published" when="2000-05">2000-05</date><biblScope unit="volume">94</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="305">305</biblScope><biblScope unit="page" to="309">309</biblScope></imprint><idno type="ISSN">0035-9203</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0035-9203</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Malawi</term><term>extrapulmonary tuberculosis</term><term>human immunodeficiency virus</term><term>mortality</term><term>smear-negative tuberculosis</term><term>smear-positive tuberculosis</term><term>tuberculosis</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract">There is little information about long-term follow-up in patients with smear-negative pulmonary tuberculosis (PTB) or extrapulmonary tuberculosis (EPTB) who have been treated under routine programme conditions in sub-Saharan Africa. A prospective study was carried out to determine outcome 32 months from start of treatment in an unselected cohort of 827 adult TB inpatients registered at Zomba Hospital, Malawi, in 1 July–31 December 1995. By 32 months, 351 (42%) patients had died. Death rates were 30% (95% confidence interval [95% CI] 25–35%) in 386 patients with smear-positive PTB, 60% (95% CI 53–67%) in 211 patients with smear-negative PTB and 47% (95% CI 40–54%) in 230 patients with EPTB. Of the 793 patients with concordant HIV test results 612 (77%) were HIV seropositive: 47% HIV-positive patients were dead by 32 months compared with 27% HIV-negative patients (adjusted hazard ratio [HR] 2·3; 95% CI 1·7-3·1, P < 0·001). Smear-negative PTB patients had the highest death rates during the 32-month follow-up (HR 2·7; 95% CI 2·1–3·5, P < 0·001 compared to smear-positive patients), followed by EPTB patients (HR 1·9; 95% CI 1·5-2·5, P < 0·001 compared to smear-positive patients). When analysis was restricted to after the treatment period had finished (i.e., months 12–32), the differences in mortality were maintained for HIV-serostatus and for types of TB. Low-cost, easy to implement strategies for reducing mortality in HIV-positive TB patients in sub-Saharan Africa (such as the use of trimethoprim-sulphamethoxazole prophylaxis) need to be tested urgently in programme settings.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>C. Kang'ombe</name><affiliations><json:string>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</json:string></affiliations></json:item><json:item><name>A.D. Harries</name><affiliations><json:string>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</json:string><json:string>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</json:string><json:string>E-mail: c-cruz@dfid.gtnet.gov.uk</json:string></affiliations></json:item><json:item><name>H. Banda</name><affiliations><json:string>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</json:string></affiliations></json:item><json:item><name>D.S. Nyangulu</name><affiliations><json:string>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</json:string></affiliations></json:item><json:item><name>C.J.M. Whitty</name><affiliations><json:string>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</json:string><json:string>Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK</json:string></affiliations></json:item><json:item><name>F.M.L. Salaniponi</name><affiliations><json:string>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</json:string></affiliations></json:item><json:item><name>D. Maher</name><affiliations><json:string>Global Tuberculosis Programme, World Health Organization, CH-1211 Geneva 27, Switzerland</json:string></affiliations></json:item><json:item><name>P. Nunn</name><affiliations><json:string>Global Tuberculosis Programme, World Health Organization, CH-1211 Geneva 27, Switzerland</json:string></affiliations></json:item></author><subject><json:item><value>tuberculosis</value></json:item><json:item><value>human immunodeficiency virus</value></json:item><json:item><value>smear-positive tuberculosis</value></json:item><json:item><value>smear-negative tuberculosis</value></json:item><json:item><value>extrapulmonary tuberculosis</value></json:item><json:item><value>mortality</value></json:item><json:item><value>Malawi</value></json:item></subject><language><json:string>unknown</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>There is little information about long-term follow-up in patients with smear-negative pulmonary tuberculosis (PTB) or extrapulmonary tuberculosis (EPTB) who have been treated under routine programme conditions in sub-Saharan Africa. A prospective study was carried out to determine outcome 32 months from start of treatment in an unselected cohort of 827 adult TB inpatients registered at Zomba Hospital, Malawi, in 1 July–31 December 1995. By 32 months, 351 (42%) patients had died. Death rates were 30% (95% confidence interval [95% CI] 25–35%) in 386 patients with smear-positive PTB, 60% (95% CI 53–67%) in 211 patients with smear-negative PTB and 47% (95% CI 40–54%) in 230 patients with EPTB. Of the 793 patients with concordant HIV test results 612 (77%) were HIV seropositive: 47% HIV-positive patients were dead by 32 months compared with 27% HIV-negative patients (adjusted hazard ratio [HR] 2·3; 95% CI 1·7-3·1, P > 0·001). Smear-negative PTB patients had the highest death rates during the 32-month follow-up (HR 2·7; 95% CI 2·1–3·5, P > 0·001 compared to smear-positive patients), followed by EPTB patients (HR 1·9; 95% CI 1·5-2·5, P > 0·001 compared to smear-positive patients). When analysis was restricted to after the treatment period had finished (i.e., months 12–32), the differences in mortality were maintained for HIV-serostatus and for types of TB. Low-cost, easy to implement strategies for reducing mortality in HIV-positive TB patients in sub-Saharan Africa (such as the use of trimethoprim-sulphamethoxazole prophylaxis) need to be tested urgently in programme settings.</abstract><qualityIndicators><score>8.501</score><pdfWordCount>3597</pdfWordCount><pdfCharCount>24280</pdfCharCount><pdfVersion>1.4</pdfVersion><pdfPageCount>5</pdfPageCount><pdfPageSize>576 x 828 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>242</abstractWordCount><abstractCharCount>1597</abstractCharCount><keywordCount>7</keywordCount></qualityIndicators><title>High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up</title><genre><json:string>research-article</json:string></genre><host><title>Transactions of The Royal Society of Tropical Medicine and Hygiene</title><language><json:string>unknown</json:string></language><issn><json:string>0035-9203</json:string></issn><eissn><json:string>1878-3503</json:string></eissn><publisherId><json:string>trstmh</json:string></publisherId><volume>94</volume><issue>3</issue><pages><first>305</first><last>309</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>social science</json:string><json:string>public, environmental & occupational health</json:string><json:string>science</json:string><json:string>tropical medicine</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>tropical medicine</json:string></scienceMetrix></categories><publicationDate>2000</publicationDate><copyrightDate>2000</copyrightDate><doi><json:string>10.1016/S0035-9203(00)90335-3</json:string></doi><id>FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">Royal Society of Tropical Medicine and Hygiene</publisher><availability><licence><p>oup</p></licence></availability><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-GTWS0RDP-M"></p><date>2000</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note><note>Clinical and pathological studies</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up</title><author xml:id="author-0000"><persName><forename type="first">C.</forename><surname>Kang'ombe</surname></persName><affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</affiliation></author><author xml:id="author-0001" corresp="yes"><persName><forename type="first">A.D.</forename><surname>Harries</surname></persName><email>c-cruz@dfid.gtnet.gov.uk</email><email>c-cruz@dfid.gtnet.gov.uk</email><affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</affiliation><affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</affiliation><affiliation></affiliation></author><author xml:id="author-0002"><persName><forename type="first">H.</forename><surname>Banda</surname></persName><affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</affiliation></author><author xml:id="author-0003"><persName><forename type="first">D.S.</forename><surname>Nyangulu</surname></persName><affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</affiliation></author><author xml:id="author-0004"><persName><forename type="first">C.J.M.</forename><surname>Whitty</surname></persName><affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</affiliation><affiliation>Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK</affiliation></author><author xml:id="author-0005"><persName><forename type="first">F.M.L.</forename><surname>Salaniponi</surname></persName><affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</affiliation></author><author xml:id="author-0006"><persName><forename type="first">D.</forename><surname>Maher</surname></persName><affiliation>Global Tuberculosis Programme, World Health Organization, CH-1211 Geneva 27, Switzerland</affiliation></author><author xml:id="author-0007"><persName><forename type="first">P.</forename><surname>Nunn</surname></persName><affiliation>Global Tuberculosis Programme, World Health Organization, CH-1211 Geneva 27, Switzerland</affiliation></author><idno type="istex">FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1</idno><idno type="ark">ark:/67375/HXZ-SCZL9D5T-1</idno><idno type="DOI">10.1016/S0035-9203(00)90335-3</idno></analytic><monogr><title level="j">Transactions of The Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbrev">Trans R Soc Trop Med Hyg</title><idno type="pISSN">0035-9203</idno><idno type="eISSN">1878-3503</idno><idno type="publisher-id">trstmh</idno><idno type="PublisherID-hwp">trstmh</idno><imprint><publisher>Royal Society of Tropical Medicine and Hygiene</publisher><date type="published" when="2000-05"></date><biblScope unit="volume">94</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="305">305</biblScope><biblScope unit="page" to="309">309</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2000</date></creation><abstract><p>There is little information about long-term follow-up in patients with smear-negative pulmonary tuberculosis (PTB) or extrapulmonary tuberculosis (EPTB) who have been treated under routine programme conditions in sub-Saharan Africa. A prospective study was carried out to determine outcome 32 months from start of treatment in an unselected cohort of 827 adult TB inpatients registered at Zomba Hospital, Malawi, in 1 July–31 December 1995. By 32 months, 351 (42%) patients had died. Death rates were 30% (95% confidence interval [95% CI] 25–35%) in 386 patients with smear-positive PTB, 60% (95% CI 53–67%) in 211 patients with smear-negative PTB and 47% (95% CI 40–54%) in 230 patients with EPTB. Of the 793 patients with concordant HIV test results 612 (77%) were HIV seropositive: 47% HIV-positive patients were dead by 32 months compared with 27% HIV-negative patients (adjusted hazard ratio [HR] 2·3; 95% CI 1·7-3·1, P < 0·001). Smear-negative PTB patients had the highest death rates during the 32-month follow-up (HR 2·7; 95% CI 2·1–3·5, P < 0·001 compared to smear-positive patients), followed by EPTB patients (HR 1·9; 95% CI 1·5-2·5, P < 0·001 compared to smear-positive patients). When analysis was restricted to after the treatment period had finished (i.e., months 12–32), the differences in mortality were maintained for HIV-serostatus and for types of TB. Low-cost, easy to implement strategies for reducing mortality in HIV-positive TB patients in sub-Saharan Africa (such as the use of trimethoprim-sulphamethoxazole prophylaxis) need to be tested urgently in programme settings.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>tuberculosis</term></item><item><term>human immunodeficiency virus</term></item><item><term>smear-positive tuberculosis</term></item><item><term>smear-negative tuberculosis</term></item><item><term>extrapulmonary tuberculosis</term></item><item><term>mortality</term></item><item><term>Malawi</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2000-05">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup, element #text not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article">
<front>
<journal-meta>
<journal-id journal-id-type="hwp">trstmh</journal-id>
<journal-id journal-id-type="publisher-id">trstmh</journal-id>
<journal-title>Transactions of The Royal Society of Tropical Medicine and Hygiene</journal-title>
<abbrev-journal-title>Trans R Soc Trop Med Hyg</abbrev-journal-title>
<issn pub-type="ppub">0035-9203</issn>
<issn pub-type="epub">1878-3503</issn>
<publisher>
<publisher-name>Royal Society of Tropical Medicine and Hygiene</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.1016/S0035-9203(00)90335-3</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Articles</subject></subj-group></article-categories>
<title-group>
<article-title>High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Kang'ombe</surname>
<given-names>C.</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Harries</surname>
<given-names>A.D.</given-names></name><xref ref-type="corresp" rid="COR1"><sup>∗</sup></xref><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Banda</surname>
<given-names>H.</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Nyangulu</surname>
<given-names>D.S.</given-names></name><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Whitty</surname>
<given-names>C.J.M.</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref><xref ref-type="aff" rid="AFF3"><sup>3</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Salaniponi</surname>
<given-names>F.M.L.</given-names></name><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Maher</surname>
<given-names>D.</given-names></name><xref ref-type="aff" rid="AFF4"><sup>4</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Nunn</surname>
<given-names>P.</given-names></name><xref ref-type="aff" rid="AFF4"><sup>4</sup></xref>
</contrib>
<aff id="AFF1">
<label>a</label>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</aff>
<aff id="AFF2">
<label>b</label>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</aff>
<aff id="AFF3">
<label>c</label>Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK</aff>
<aff id="AFF4">
<label>d</label>Global Tuberculosis Programme, World Health Organization, CH-1211 Geneva 27, Switzerland</aff></contrib-group>
<author-notes>
<fn>
<p>Clinical and pathological studies</p></fn>
<corresp id="COR1">
<label>∗</label>Address for correspondence: Professor A. D. Harries, ODA-Malawi TB Project, British High Commission, P.O. Box 30042, Lilongwe 3, Malawi; fax +265 782 657. <email>c-cruz@dfid.gtnet.gov.uk</email></corresp></author-notes>
<pub-date pub-type="ppub">
<month>5</month>
<year>2000</year></pub-date>
<volume>94</volume>
<issue>3</issue>
<fpage>305</fpage>
<lpage>309</lpage>
<history><date date-type="received"><day>15</day>
<month>9</month>
<year>1999</year></date><date date-type="rev-recd"><day>3</day>
<month>11</month>
<year>1999</year></date><date date-type="accepted"><day>3</day>
<month>11</month>
<year>1999</year></date></history>
<permissions><copyright-year>2000</copyright-year></permissions>
<abstract>
<p>There is little information about long-term follow-up in patients with smear-negative pulmonary tuberculosis (PTB) or extrapulmonary tuberculosis (EPTB) who have been treated under routine programme conditions in sub-Saharan Africa. A prospective study was carried out to determine outcome 32 months from start of treatment in an unselected cohort of 827 adult TB inpatients registered at Zomba Hospital, Malawi, in 1 July–31 December 1995. By 32 months, 351 (42%) patients had died. Death rates were 30% (95% confidence interval [95% CI] 25–35%) in 386 patients with smear-positive PTB, 60% (95% CI 53–67%) in 211 patients with smear-negative PTB and 47% (95% CI 40–54%) in 230 patients with EPTB. Of the 793 patients with concordant HIV test results 612 (77%) were HIV seropositive: 47% HIV-positive patients were dead by 32 months compared with 27% HIV-negative patients (adjusted hazard ratio [HR] 2·3; 95% CI 1·7-3·1, <italic>P</italic> < 0·001). Smear-negative PTB patients had the highest death rates during the 32-month follow-up (HR 2·7; 95% CI 2·1–3·5, <italic>P</italic> < 0·001 compared to smear-positive patients), followed by EPTB patients (HR 1·9; 95% CI 1·5-2·5, <italic>P</italic> < 0·001 compared to smear-positive patients). When analysis was restricted to after the treatment period had finished (i.e., months 12–32), the differences in mortality were maintained for HIV-serostatus and for types of TB. Low-cost, easy to implement strategies for reducing mortality in HIV-positive TB patients in sub-Saharan Africa (such as the use of trimethoprim-sulphamethoxazole prophylaxis) need to be tested urgently in programme settings.</p></abstract>
<kwd-group xml:lang="en">
<title>Keywords</title>
<kwd>tuberculosis</kwd>
<kwd><italic>Mycobacterium tuberculosis</italic></kwd>
<kwd>human immunodeficiency virus</kwd>
<kwd>smear-positive tuberculosis</kwd>
<kwd>smear-negative tuberculosis</kwd>
<kwd>extrapulmonary tuberculosis</kwd>
<kwd>mortality</kwd>
<kwd>Malawi</kwd></kwd-group>
<custom-meta-wrap>
<custom-meta>
<meta-name>cover-date</meta-name>
<meta-value>May-June 2000</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<back>
<ref-list>
<title>References</title>
<ref id="BIB1">
<label>Connolly et al., 1999</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Connolly</surname>
<given-names>C.</given-names></name>
<name>
<surname>Reid</surname>
<given-names>A.</given-names></name>
<name>
<surname>Davies</surname>
<given-names>G.</given-names></name>
<name>
<surname>Sturm</surname>
<given-names>W.</given-names></name>
<name>
<surname>McAdam</surname>
<given-names>K.P.W.J.</given-names></name>
<name>
<surname>Wilkinson</surname>
<given-names>D.</given-names></name>
</person-group>
<article-title>Relapse and mortality among HIV-infected and uninfected patients with tuberculosis successfully treated with twice weekly directly observed therapy in rural South Africa</article-title>
<source>AIDS</source>
<year>1999</year>
<volume>13</volume>
<fpage>1543</fpage>
<lpage>1547</lpage>
</nlm-citation>
</ref>
<ref id="BIB2">
<label>Crofton et al., 1999</label>
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname>Crofton</surname>
<given-names>J.</given-names></name>
<name>
<surname>Horne</surname>
<given-names>N.</given-names></name>
<name>
<surname>Miller</surname>
<given-names>F.</given-names></name>
</person-group>
<source>Clinical Tuberculosis</source>
<year>1999</year><edition>second edition</edition>
<publisher-loc>London and Basingstoke</publisher-loc>
<publisher-name>MacMillan Education Ltd</publisher-name>
</nlm-citation>
</ref>
<ref id="BIB3">
<label>De Cock et al., 1992</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>De Cock</surname>
<given-names>K.M.</given-names></name>
<name>
<surname>Soro</surname>
<given-names>B.</given-names></name>
<name>
<surname>Coulibaly</surname>
<given-names>I.M.</given-names></name>
<name>
<surname>Lucas</surname>
<given-names>S.B.</given-names></name>
</person-group>
<article-title>Tuberculosis and HIV infection in sub-Saharan Africa</article-title>
<source>Journal of the American Medical Association</source>
<year>1992</year>
<volume>268</volume>
<fpage>1581</fpage>
<lpage>1587</lpage>
</nlm-citation>
</ref>
<ref id="BIB4">
<label>Elliott et al., 1995</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Elliott</surname>
<given-names>A.M.</given-names></name>
<name>
<surname>Halwiindi</surname>
<given-names>B.</given-names></name>
<name>
<surname>Hayes</surname>
<given-names>R.J.</given-names></name>
<name>
<surname>Luo</surname>
<given-names>N.</given-names></name>
<name>
<surname>Mwinga</surname>
<given-names>A.G.</given-names></name>
<name>
<surname>Tembo</surname>
<given-names>G.</given-names></name>
<name>
<surname>Machiels</surname>
<given-names>L.</given-names></name>
<name>
<surname>Steenbergen</surname>
<given-names>G.</given-names></name>
<name>
<surname>Pobee</surname>
<given-names>J.O.M.</given-names></name>
<name>
<surname>Nunn</surname>
<given-names>P.</given-names></name>
<name>
<surname>McAdam</surname>
<given-names>K.P.W.J.</given-names></name>
</person-group>
<article-title>The impact of human immunodeficiency virus on mortality of patients treated for tuberculosis in a cohort study in Zambia</article-title>
<source>Transactions of the Royal Society of Tropical Medicine and Hygiene</source>
<year>1995</year>
<volume>89</volume>
<fpage>78</fpage>
<lpage>82</lpage>
</nlm-citation>
</ref>
<ref id="BIB5">
<label>Enarson et al., 1996</label>
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname>Enarson</surname>
<given-names>D.A.</given-names></name>
<name>
<surname>Rieder</surname>
<given-names>H.L.</given-names></name>
<name>
<surname>Arnadottir</surname>
<given-names>T.</given-names></name>
<name>
<surname>Trebucq</surname>
<given-names>A.</given-names></name>
</person-group>
<source>Tuberculosis Guide for Low Income Countries</source>
<year>1996</year><edition>fourth edition</edition>
<publisher-loc>Paris</publisher-loc>
<publisher-name>International Union against Tuberculosis and Lung Disease</publisher-name>
</nlm-citation>
</ref>
<ref id="BIB6">
<label>Garin et al., 1997</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Garin</surname>
<given-names>B.</given-names></name>
<name>
<surname>Glaziou</surname>
<given-names>P.</given-names></name>
<name>
<surname>Kassa-Kelembho</surname>
<given-names>E.</given-names></name>
<name>
<surname>Yassibanda</surname>
<given-names>S.</given-names></name>
<name>
<surname>Mbelesso</surname>
<given-names>P.</given-names></name>
<name>
<surname>Morvan</surname>
<given-names>J.</given-names></name>
</person-group>
<article-title>High mortality rates among patients with tuberculosis in Bangui, Central African Republic</article-title>
<source>Lancet</source>
<year>1997</year>
<volume>350</volume>
<fpage>1298</fpage>
</nlm-citation>
</ref>
<ref id="BIB7">
<label>Gilks, 1993</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gilks</surname>
<given-names>C.F.</given-names></name>
</person-group>
<article-title>The clinical challenge of the HIV epidemic in the developing world</article-title>
<source>Lancet</source>
<year>1993</year>
<volume>342</volume>
<fpage>1037</fpage>
<lpage>1039</lpage>
</nlm-citation>
</ref>
<ref id="BIB8">
<label>Grant et al., 1997</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Grant</surname>
<given-names>A.D.</given-names></name>
<name>
<surname>Djomand</surname>
<given-names>G.</given-names></name>
<name>
<surname>Smets</surname>
<given-names>P.</given-names></name>
<name>
<surname>Kadio</surname>
<given-names>A.</given-names></name>
<name>
<surname>Coulibaly</surname>
<given-names>M.</given-names></name>
<name>
<surname>Kakou</surname>
<given-names>A.</given-names></name>
<name>
<surname>Maurice</surname>
<given-names>C.</given-names></name>
<name>
<surname>Whitaker</surname>
<given-names>J.P.</given-names></name>
<name>
<surname>Sylla-Koko</surname>
<given-names>F.</given-names></name>
<name>
<surname>Bonard</surname>
<given-names>D.</given-names></name>
<name>
<surname>Wiktor</surname>
<given-names>S.Z.</given-names></name>
<name>
<surname>Hayes</surname>
<given-names>R.J.</given-names></name>
<name>
<surname>De Cock</surname>
<given-names>K.M.</given-names></name>
<name>
<surname>Greenberg</surname>
<given-names>A.E.</given-names></name>
</person-group>
<article-title>Profound immunosuppression across the spectrum of opportunistic disease among hospitalized HIV-infected adults in Abidjan, Cote d'Ivoire</article-title>
<source>AIDS</source>
<year>1997</year>
<volume>11</volume>
<fpage>1357</fpage>
<lpage>1364</lpage>
</nlm-citation>
</ref>
<ref id="BIB9">
<label>Greenberg et al., 1995</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Greenberg</surname>
<given-names>A.E.</given-names></name>
<name>
<surname>Lucas</surname>
<given-names>S.</given-names></name>
<name>
<surname>Tossou</surname>
<given-names>O.</given-names></name>
<name>
<surname>Coulibaly</surname>
<given-names>I.-M.</given-names></name>
<name>
<surname>Coulibaly</surname>
<given-names>D.</given-names></name>
<name>
<surname>Kassim</surname>
<given-names>S.</given-names></name>
<name>
<surname>Ackah</surname>
<given-names>A.</given-names></name>
<name>
<surname>De Cock</surname>
<given-names>K.M.</given-names></name>
</person-group>
<article-title>Autopsy-proven causes of death in HIV-infected patients treated for tuberculosis in Abidjan, Cote d'Ivoire</article-title>
<source>AIDS</source>
<year>1995</year>
<volume>9</volume>
<fpage>1251</fpage>
<lpage>1254</lpage>
</nlm-citation>
</ref>
<ref id="BIB10">
<label>Harries et al., 1995</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Harries</surname>
<given-names>A.D.</given-names></name>
<name>
<surname>Maher</surname>
<given-names>D.</given-names></name>
<name>
<surname>Mvula</surname>
<given-names>B.</given-names></name>
<name>
<surname>Nyangulu</surname>
<given-names>D.S.</given-names></name>
</person-group>
<article-title>An audit of HIV testing and HIV serostatus in tuberculosis patients, Blantyre, Malawi</article-title>
<source>Tuberculosis and Lung Disease</source>
<year>1995</year>
<volume>76</volume>
<fpage>413</fpage>
<lpage>417</lpage>
</nlm-citation>
</ref>
<ref id="BIB11">
<label>Harries et al., 1998a</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Harries</surname>
<given-names>A.D.</given-names></name>
<name>
<surname>Nyangulu</surname>
<given-names>D.S.</given-names></name>
<name>
<surname>Kang'ombe</surname>
<given-names>C.</given-names></name>
<name>
<surname>Ndalama</surname>
<given-names>D.</given-names></name>
<name>
<surname>Glynn</surname>
<given-names>J.R.</given-names></name>
<name>
<surname>Banda</surname>
<given-names>H.</given-names></name>
<name>
<surname>Wirima</surname>
<given-names>J.J.</given-names></name>
<name>
<surname>Salaniponi</surname>
<given-names>F.M.</given-names></name>
<name>
<surname>Liomba</surname>
<given-names>G.</given-names></name>
<name>
<surname>Maher</surname>
<given-names>D.</given-names></name>
<name>
<surname>Nunn</surname>
<given-names>P.</given-names></name>
</person-group>
<article-title>Treatment outcome of an unselected cohort of tuberculosis patients in relation to human immunodeficiency virus serostatus in Zomba hospital, Malawi</article-title>
<source>Transactions of the Royal Society of Tropical Medicine and Hygiene</source>
<year>1998</year>
<volume>92</volume>
<fpage>343</fpage>
<lpage>347</lpage>
</nlm-citation>
</ref>
<ref id="BIB12">
<label>Harries et al., 1998b</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Harries</surname>
<given-names>A.D.</given-names></name>
<name>
<surname>Maher</surname>
<given-names>D.</given-names></name>
<name>
<surname>Nunn</surname>
<given-names>P.</given-names></name>
</person-group>
<article-title>An approach to the problems of diagnosing and treating adult smear-negative pulmonary tuberculosis in high-HIV-prevalence settings in sub-Saharan Africa</article-title>
<source>Bulletin of the World Health Organization</source>
<year>1998</year>
<volume>76</volume>
<fpage>651</fpage>
<lpage>662</lpage>
</nlm-citation>
</ref>
<ref id="BIB13">
<label>Harries et al., 1999</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Harries</surname>
<given-names>A.D.</given-names></name>
<name>
<surname>Nyirenda</surname>
<given-names>T.E.</given-names></name>
<name>
<surname>Banerjee</surname>
<given-names>A.</given-names></name>
<name>
<surname>Boeree</surname>
<given-names>M.J.</given-names></name>
<name>
<surname>Salaniponi</surname>
<given-names>F.M.L.</given-names></name>
</person-group>
<article-title>Treatment outcome of patients with smear-negative and smear-positive pulmonary tuberculosis in the National Tuberculosis Control Programme, Malawi</article-title>
<source>Transactions of the Royal Society of Tropical Medicine and Hygiene</source>
<year>1999</year>
<volume>93</volume>
<fpage>443</fpage>
<lpage>446</lpage>
</nlm-citation>
</ref>
<ref id="BIB14">
<label>Kassim et al., 1995</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kassim</surname>
<given-names>S.</given-names></name>
<name>
<surname>Sassan-Morokro</surname>
<given-names>M.</given-names></name>
<name>
<surname>Ackah</surname>
<given-names>A.</given-names></name>
<name>
<surname>Abouya</surname>
<given-names>L.Y.</given-names></name>
<name>
<surname>Digbeu</surname>
<given-names>H.</given-names></name>
<name>
<surname>Yesso</surname>
<given-names>G.</given-names></name>
<name>
<surname>Coulibaly</surname>
<given-names>I.-M.</given-names></name>
<name>
<surname>Coulibaly</surname>
<given-names>D.</given-names></name>
<name>
<surname>Whitaker</surname>
<given-names>P.J.</given-names></name>
<name>
<surname>Doorly</surname>
<given-names>R.</given-names></name>
<name>
<surname>Vetter</surname>
<given-names>K.M.</given-names></name>
<name>
<surname>Brattegaard</surname>
<given-names>K.</given-names></name>
<name>
<surname>Gnaore</surname>
<given-names>E.</given-names></name>
<name>
<surname>Greenberg</surname>
<given-names>A.E.</given-names></name>
<name>
<surname>Wiktor</surname>
<given-names>S.Z.</given-names></name>
<name>
<surname>De Cock</surname>
<given-names>K.M.</given-names></name>
</person-group>
<article-title>Two-year follow-up of persons with HIV-1-and HIV-2-associated pulmonary tuberculosis treated with shortcourse chemotherapy in West Africa</article-title>
<source>AIDS</source>
<year>1995</year>
<volume>9</volume>
<fpage>1185</fpage>
<lpage>1191</lpage>
</nlm-citation>
</ref>
<ref id="BIB15">
<label>Kelly et al., 1990</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kelly</surname>
<given-names>P.</given-names></name>
<name>
<surname>Burnham</surname>
<given-names>G.</given-names></name>
<name>
<surname>Radford</surname>
<given-names>C.</given-names></name>
</person-group>
<article-title>HIV seropositivity and tuberculosis in a rural Malawi hospital</article-title>
<source>Transactions of the Royal Society of Tropical Medicine and Hygiene</source>
<year>1990</year>
<volume>84</volume>
<fpage>725</fpage>
<lpage>727</lpage>
</nlm-citation>
</ref>
<ref id="BIB16">
<label>Kelly et al., 1999</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kelly</surname>
<given-names>P.M.</given-names></name>
<name>
<surname>Cumming</surname>
<given-names>R.G.</given-names></name>
<name>
<surname>Kaldor</surname>
<given-names>J.M.</given-names></name>
</person-group>
<article-title>HIV and tuberculosis in rural sub-Saharan Africa: a cohort study with two year follow-up</article-title>
<source>Transactions of the Royal Society of Tropical Medicine and Hygiene</source>
<year>1999</year>
<volume>93</volume>
<fpage>287</fpage>
<lpage>293</lpage>
</nlm-citation>
</ref>
<ref id="BIB17">
<label>Kool et al., 1990</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kool</surname>
<given-names>H.E.</given-names></name>
<name>
<surname>Bloemkolk</surname>
<given-names>D.</given-names></name>
<name>
<surname>Reeve</surname>
<given-names>P.A.</given-names></name>
<name>
<surname>Danner</surname>
<given-names>S.A.</given-names></name>
</person-group>
<article-title>HIV seropositivity and tuberculosis in a large general hospital in Malawi</article-title>
<source>Tropical and Geographical Medicine</source>
<year>1990</year>
<volume>42</volume>
<fpage>128</fpage>
<lpage>132</lpage>
</nlm-citation>
</ref>
<ref id="BIB18">
<label>Mocroft et al., 1998</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mocroft</surname>
<given-names>A.</given-names></name>
<name>
<surname>Vella</surname>
<given-names>S.</given-names></name>
<name>
<surname>Benfield</surname>
<given-names>T.L.</given-names></name>
<name>
<surname>Chiesi</surname>
<given-names>A.</given-names></name>
<name>
<surname>Miller</surname>
<given-names>V.</given-names></name>
<name>
<surname>Gargalianos</surname>
<given-names>P.</given-names></name>
<name>
<surname>d'Arminio Monforte</surname>
<given-names>A.</given-names></name>
<name>
<surname>Yust</surname>
<given-names>I.</given-names></name>
<name>
<surname>Bruun</surname>
<given-names>J.N.</given-names></name>
<name>
<surname>Phillips</surname>
<given-names>A.N.</given-names></name><collab>Lundgren, J. D. for the EuroSIDA Study Group</collab>
</person-group>
<article-title>Changing patterns of mortality across Europe in patients infected with HIV-1</article-title>
<source>Lancet</source>
<year>1998</year>
<volume>352</volume>
<fpage>1725</fpage>
<lpage>1730</lpage>
</nlm-citation>
</ref>
<ref id="BIB19">
<label>Murray et al., 1991</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Murray</surname>
<given-names>C.J.L.</given-names></name>
<name>
<surname>Dejonghe</surname>
<given-names>E.</given-names></name>
<name>
<surname>Chum</surname>
<given-names>H.J.</given-names></name>
<name>
<surname>Nyangulu</surname>
<given-names>D.S.</given-names></name>
<name>
<surname>Salomao</surname>
<given-names>A.</given-names></name>
<name>
<surname>Styblo</surname>
<given-names>K.</given-names></name>
</person-group>
<article-title>Cost effectiveness of chemotherapy for pulmonary tuberculosis in three sub-Saharan African countries</article-title>
<source>Lancet</source>
<year>1991</year>
<volume>338</volume>
<fpage>1305</fpage>
<lpage>1308</lpage>
</nlm-citation>
</ref>
<ref id="BIB20">
<label>Okwera et al., 1994</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Okwera</surname>
<given-names>A.</given-names></name>
<name>
<surname>Whalen</surname>
<given-names>C.</given-names></name>
<name>
<surname>Byekwaso</surname>
<given-names>F.</given-names></name>
<name>
<surname>Vjecha</surname>
<given-names>M.</given-names></name>
<name>
<surname>Johnson</surname>
<given-names>J.</given-names></name>
<name>
<surname>Huebner</surname>
<given-names>R.</given-names></name>
<name>
<surname>Mugwera</surname>
<given-names>R.</given-names></name>
<name>
<surname>Ellner</surname>
<given-names>J.</given-names></name><collab>The Makerere University-Case Western University Research Collaboration</collab>
</person-group>
<article-title>Randomised trial of thiacetazone and rifampicin-containing regimens for pulmonary tuberculosis in HIV-infected Ugandans</article-title>
<source>Lancet</source>
<year>1994</year>
<volume>344</volume>
<fpage>1323</fpage>
<lpage>1328</lpage>
</nlm-citation>
</ref>
<ref id="BIB21">
<label>Palella et al., 1998</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Palella</surname>
<given-names>F.J.</given-names></name>
<name>
<surname>Delaney</surname>
<given-names>K.M.</given-names></name>
<name>
<surname>Moorman</surname>
<given-names>A.C.</given-names></name>
<name>
<surname>Loveless</surname>
<given-names>M.O.</given-names></name>
<name>
<surname>Fuhrer</surname>
<given-names>J.</given-names></name>
<name>
<surname>Satten</surname>
<given-names>G.A.</given-names></name>
<name>
<surname>Aschman</surname>
<given-names>D.J.</given-names></name>
<name>
<surname>Holmberg</surname>
<given-names>S.D.</given-names></name>
<name>
<surname>The HIV Outpatient Study Investigations</surname></name>
</person-group>
<article-title>Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection</article-title>
<source>New England Journal of Medicine</source>
<year>1998</year>
<volume>338</volume>
<fpage>853</fpage>
<lpage>860</lpage>
</nlm-citation>
</ref>
<ref id="BIB22">
<label>Perriens et al., 1995</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Perriens</surname>
<given-names>J.H.</given-names></name>
<name>
<surname>St Louis</surname>
<given-names>M.E.</given-names></name>
<name>
<surname>Mukadi</surname>
<given-names>Y.B.</given-names></name>
<name>
<surname>Brown</surname>
<given-names>C.</given-names></name>
<name>
<surname>Prignot</surname>
<given-names>J.</given-names></name>
<name>
<surname>Pouthier</surname>
<given-names>F.</given-names></name>
<name>
<surname>Portaels</surname>
<given-names>F.</given-names></name>
<name>
<surname>Willame</surname>
<given-names>J.C.</given-names></name>
<name>
<surname>Manadala</surname>
<given-names>J.K.</given-names></name>
<name>
<surname>Kaboto</surname>
<given-names>M.</given-names></name>
<name>
<surname>Ryder</surname>
<given-names>R.W.</given-names></name>
<name>
<surname>Roscigno</surname>
<given-names>G.</given-names></name>
<name>
<surname>Piot</surname>
<given-names>P.</given-names></name>
</person-group>
<article-title>Pulmonary tuberculosis in HIV-infected patients in Zaire. A controlled trial of treatment for either 6 or 12 months</article-title>
<source>New England Journal of Medicine</source>
<year>1995</year>
<volume>332</volume>
<fpage>779</fpage>
<lpage>784</lpage>
</nlm-citation>
</ref>
<ref id="BIB23">
<label>Richter et al., 1991</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Richter</surname>
<given-names>C.</given-names></name>
<name>
<surname>Ndosi</surname>
<given-names>B.</given-names></name>
<name>
<surname>Mwammy</surname>
<given-names>A.S.</given-names></name>
<name>
<surname>Mbwambo</surname>
<given-names>R.K.</given-names></name>
</person-group>
<article-title>Extrapulmonary tuberculosis—a simple diagnosis?</article-title>
<source>Tropical and Geographical Medicine</source>
<year>1991</year>
<volume>43</volume>
<fpage>375</fpage>
<lpage>378</lpage>
</nlm-citation>
</ref>
<ref id="BIB24">
<label>Shafer et al., 1996</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shafer</surname>
<given-names>R.W.</given-names></name>
<name>
<surname>Bloch</surname>
<given-names>A.B.</given-names></name>
<name>
<surname>Larkin</surname>
<given-names>C.</given-names></name>
<name>
<surname>Vasudavan</surname>
<given-names>V.</given-names></name>
<name>
<surname>Seligman</surname>
<given-names>S.</given-names></name>
<name>
<surname>Dehovitz</surname>
<given-names>J.D.</given-names></name>
<name>
<surname>DiFerdinando</surname>
<given-names>G.</given-names></name>
<name>
<surname>Stoneburner</surname>
<given-names>R.</given-names></name>
<name>
<surname>Cauthen</surname>
<given-names>G.</given-names></name>
</person-group>
<article-title>Predictors of survival in HIV-infected tuberculosis patients</article-title>
<source>AIDS</source>
<year>1996</year>
<volume>10</volume>
<fpage>269</fpage>
<lpage>272</lpage>
</nlm-citation>
</ref>
<ref id="BIB25">
<label>WHO, 1997</label>
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname>WHO</surname></name>
</person-group>
<article-title>Treatment of tuberculosis: guidelines for national programmes</article-title>
<source>WHO/TB/97.220</source>
<year>1997</year><edition>second edition</edition>
<publisher-loc>Geneva</publisher-loc>
<publisher-name>World Health Organization</publisher-name>
</nlm-citation>
</ref>
<ref id="BIB26">
<label>Wiktor et al., 1999</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wiktor</surname>
<given-names>S.Z.</given-names></name>
<name>
<surname>Sassan-Morokro</surname>
<given-names>M.</given-names></name>
<name>
<surname>Grant</surname>
<given-names>A.D.</given-names></name>
<name>
<surname>Abouya</surname>
<given-names>L.</given-names></name>
<name>
<surname>Karon</surname>
<given-names>J.M.</given-names></name>
<name>
<surname>Maurice</surname>
<given-names>C.</given-names></name>
<name>
<surname>Djomand</surname>
<given-names>G.</given-names></name>
<name>
<surname>Ackah</surname>
<given-names>A.</given-names></name>
<name>
<surname>Domoua</surname>
<given-names>K.</given-names></name>
<name>
<surname>Kadio</surname>
<given-names>A.</given-names></name>
<name>
<surname>Yapi</surname>
<given-names>A.</given-names></name>
<name>
<surname>Combe</surname>
<given-names>P.</given-names></name>
<name>
<surname>Tossou</surname>
<given-names>O.</given-names></name>
<name>
<surname>Roels</surname>
<given-names>T.H.</given-names></name>
<name>
<surname>Lackritz</surname>
<given-names>E.M.</given-names></name>
<name>
<surname>Coulibaly</surname>
<given-names>D.</given-names></name>
<name>
<surname>De Cock</surname>
<given-names>K.M.</given-names></name>
<name>
<surname>Coulibaly</surname>
<given-names>I.-M.</given-names></name>
<name>
<surname>Greenberg</surname>
<given-names>A.E.</given-names></name>
</person-group>
<article-title>Efficacy of trimethoprim-sulphamethoxazole prophylaxis to decrease morbidity and mortality in HIV-1-infected patients with tuberculosis in Abidjan, Cote d'Ivoire: a randomised controlled trial</article-title>
<source>Lancet</source>
<year>1999</year>
<volume>353</volume>
<fpage>1469</fpage>
<lpage>1475</lpage>
</nlm-citation>
</ref>
<ref id="BIB27">
<label>Wood and Post, 1997</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wood</surname>
<given-names>R.</given-names></name>
<name>
<surname>Post</surname>
<given-names>F.A.</given-names></name>
</person-group>
<article-title>Survival of human immunodeficiency virus-infected persons with pulmonary tuberculosis</article-title>
<source>International Journal of Tuberculosis and Lung Disease</source>
<year>1997</year>
<volume>1</volume>
<fpage>87</fpage>
</nlm-citation>
</ref>
</ref-list>
</back>
</article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up</title></titleInfo><name type="personal"><namePart type="given">C.</namePart><namePart type="family">Kang'ombe</namePart><affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">A.D.</namePart><namePart type="family">Harries</namePart><affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</affiliation><affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</affiliation><affiliation>E-mail: c-cruz@dfid.gtnet.gov.uk</affiliation><affiliation></affiliation><affiliation>E-mail: c-cruz@dfid.gtnet.gov.uk</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">H.</namePart><namePart type="family">Banda</namePart><affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D.S.</namePart><namePart type="family">Nyangulu</namePart><affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C.J.M.</namePart><namePart type="family">Whitty</namePart><affiliation>College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi</affiliation><affiliation>Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F.M.L.</namePart><namePart type="family">Salaniponi</namePart><affiliation>National Tuberculosis Control Programme, Ministry of Health, P.O. Box 30377, Capital City, Lilongwe, Malawi</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D.</namePart><namePart type="family">Maher</namePart><affiliation>Global Tuberculosis Programme, World Health Organization, CH-1211 Geneva 27, Switzerland</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P.</namePart><namePart type="family">Nunn</namePart><affiliation>Global Tuberculosis Programme, World Health Organization, CH-1211 Geneva 27, Switzerland</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>Royal Society of Tropical Medicine and Hygiene</publisher><dateIssued encoding="w3cdtf">2000-05</dateIssued><copyrightDate encoding="w3cdtf">2000</copyrightDate></originInfo><abstract>There is little information about long-term follow-up in patients with smear-negative pulmonary tuberculosis (PTB) or extrapulmonary tuberculosis (EPTB) who have been treated under routine programme conditions in sub-Saharan Africa. A prospective study was carried out to determine outcome 32 months from start of treatment in an unselected cohort of 827 adult TB inpatients registered at Zomba Hospital, Malawi, in 1 July–31 December 1995. By 32 months, 351 (42%) patients had died. Death rates were 30% (95% confidence interval [95% CI] 25–35%) in 386 patients with smear-positive PTB, 60% (95% CI 53–67%) in 211 patients with smear-negative PTB and 47% (95% CI 40–54%) in 230 patients with EPTB. Of the 793 patients with concordant HIV test results 612 (77%) were HIV seropositive: 47% HIV-positive patients were dead by 32 months compared with 27% HIV-negative patients (adjusted hazard ratio [HR] 2·3; 95% CI 1·7-3·1, P < 0·001). Smear-negative PTB patients had the highest death rates during the 32-month follow-up (HR 2·7; 95% CI 2·1–3·5, P < 0·001 compared to smear-positive patients), followed by EPTB patients (HR 1·9; 95% CI 1·5-2·5, P < 0·001 compared to smear-positive patients). When analysis was restricted to after the treatment period had finished (i.e., months 12–32), the differences in mortality were maintained for HIV-serostatus and for types of TB. Low-cost, easy to implement strategies for reducing mortality in HIV-positive TB patients in sub-Saharan Africa (such as the use of trimethoprim-sulphamethoxazole prophylaxis) need to be tested urgently in programme settings.</abstract><note type="footnotes">Clinical and pathological studies</note><subject lang="en"><genre>Keywords</genre><topic>tuberculosis</topic><topic>human immunodeficiency virus</topic><topic>smear-positive tuberculosis</topic><topic>smear-negative tuberculosis</topic><topic>extrapulmonary tuberculosis</topic><topic>mortality</topic><topic>Malawi</topic></subject><relatedItem type="host"><titleInfo><title>Transactions of The Royal Society of Tropical Medicine and Hygiene</title></titleInfo><titleInfo type="abbreviated"><title>Trans R Soc Trop Med Hyg</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><identifier type="ISSN">0035-9203</identifier><identifier type="eISSN">1878-3503</identifier><identifier type="PublisherID">trstmh</identifier><identifier type="PublisherID-hwp">trstmh</identifier><part><date>2000</date><detail type="volume"><caption>vol.</caption><number>94</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>305</start><end>309</end></extent></part></relatedItem><identifier type="istex">FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1</identifier><identifier type="DOI">10.1016/S0035-9203(00)90335-3</identifier><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-GTWS0RDP-M">oup</recordContentSource></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1/metadata/json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Istex/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 005263 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Istex/Corpus/biblio.hfd -nk 005263 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaSubSaharaV1
|flux= Istex
|étape= Corpus
|type= RBID
|clé= ISTEX:FE4FD8E2940D3C5798A5D8845CF549EEF10F76D1
|texte= High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up
}}
| This area was generated with Dilib version V0.6.32. |  |