Effect of smear status on survival of patients previously on HAART in the first 2-months of anti-tuberculosis therapy in mulago hospital.

Abstract

INTRODUCTION: Mortality among TB patients in increased in patients who are co-infected with HIV. The aim of this study was to examine the effect of smear-positive vs. smear-negative PTB + EPTB on mortality. The study focused on TB patients who were in the first 2-months of intensive phase of TB treatment and had been on HAART before TB diagnosis. METHODS: This was a retrospective cohort study of patients enrolled from the emergency/causality ward and TB/HIV clinic in mulago hospital, kampala. A total of 152 patients were enrolled. Data was collected on social demographic information, having smear positive PTB or smear negative PTB plus EPTB, opportunistic infections, CD4 cell count, type of HAART regimen, WHO staged, time interval between initiations of anti-TB and death and date of HAART initiation. RESULTS: Five out of 13 deaths (38.5%) occurred in smear-positive PTB while 8 out of 13 deaths (61.5%) were in smear negative PTB and EPTB. Using log rank test, mortality was similar among smear positive PTB patients as compared to smear negative and EPTB patients (p-value=0.612). At multivariate level, sputum smear results was not significantly associated with survival (HR 1.05, C1=0.32-3.42), but type of HAART was significantly associated with survival (HR=7.39 C1=1.5-36.34). CONCLUSION: Sputum smear status appears not to have an effect on mortality among patients who were receiving HAART prior to diagnosis of TB and followed up for the first 2 months of intensive anti-TB therapy.