oa Southern African Journal of Epidemiology and Infection - Reducing case fatality in HIV-infected TB patients in sub-Saharan Africa : review
HIV-infected patients with tuberculosis (TB) have much higher case fatality rates compared with non-HIV-infected patients. There are various reasons for this high mortality that include delayed presentation and advanced TB at the time of diagnosis, incorrect diagnosis of smearnegative TB and HIV-related diseases. More attention must be paid to reducing the time from symptoms to diagnosis of TB, ensuring as far as possible that the diagnosis of TB is correct and administering rifampicin-throughout anti-tuberculosis treatment. In high HIV prevalence areas, all TB patients should routinely be offered HIV testing as this is the gateway to cotrimoxazole preventive therapy and antiretroviral therapy, both of which will reduce case fatality if started soon enough. Despite severe malnutrition often being present in HIV-infected TB patients, two randomised controlled trials have demonstrated no effect of nutritional supplements in reducing case fatality. The jury is still out about whether adjunctive corticosteroids have a significant benefit or not. Finally, it is important to reliably monitor treatment outcomes and to recognise that significant unreported mortality lies hidden in treatment categories such as default and transfer out.
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