Smear-positive pulmonary TB is the most infectious form of TB. Previous
studies on the effect of HIV and antiretroviral therapy on TB treatment
outcomes among these highly infectious patients demonstrated conflicting
results, reducing understanding of important issues.
All adult smear-positive pulmonary TB patients diagnosed between 2008
and 2010 in Malawi’s largest public, integrated TB/HIV clinic were
included in the study to assess treatment outcomes by HIV and
antiretroviral therapy status using logistic regression.
Of 2,361 new smear-positive pulmonary TB patients, 86% had successful
treatment outcome (were cured or completed treatment), 5% died, 6% were
lost to follow-up, 1% failed treatment, and 2% transferred-out. Overall
HIV prevalence was 56%. After adjusting for gender, age and TB
registration year, treatment success was higher among HIV-negative than
HIV-positive patients (adjusted odds ratio 1.49; 95% CI: 1.14 - 1.94).
Of 1,275 HIV-infected pulmonary TB patients, 492 (38%) received
antiretroviral therapy during the study. Pulmonary TB patients on
antiretroviral therapy were more likely to have successful treatment
outcomes than those not on ART (adjusted odds ratio : 1.83; 95% CI: 1.29
The study concluded that HIV co-infection was associated with poor TB
treatment outcomes. Despite high HIV prevalence and the integrated
TB/HIV setting, only a minority of patients started antiretroviral
therapy. Intensified patient education and provider training on the
benefits of antiretroviral therapy could increase antiretroviral therapy
uptake and improve TB treatment success among these most infectious
Tweya, H.; Feldacker, C.; Phiri, S.; Ben-Smith, A.; Fenner, L.; Jahn, A.; Kalulu, M.; Weigel, R.; Kamba, C.; Banda, R.; Egger, M.; Keiser, O. Comparison of Treatment Outcomes of New Smear-Positive Pulmonary Tuberculosis Patients by HIV and Antiretroviral Status in a TB/HIV Clinic, Malawi. PLoS ONE (2013) 8 (2) e56248. [DOI: 10.1371/journal.pone.0056248]
Comparison of treatment outcomes of new smear-positive pulmonary tuberculosis patients by HIV and Antiretroviral status in a TB/HIV Clinic, Malawi.