Causes and Outcomes of Admission and Investigation of Tuberculosis in Adults with Advanced HIV in South African Hospitals: Data from the TB Fast Track Trial

Author:

Beckwith Peter G.12,Tlali Mpho3,Charalambous Salome34,Churchyard Gavin J.1345,Fielding Katherine L.14,Hoffmann Christopher J.6,Johnson Suzanne7,Wood Natalie8,Grant Alison D.149,Karat Aaron S.1

Affiliation:

1. 1TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom;

2. 2Department of Medicine, University of Cape Town, Cape Town, South Africa;

3. 3The Aurum Institute, Johannesburg, South Africa;

4. 4School of Public Health, University of the Witwatersrand, Johannesburg, South Africa;

5. 5Advancing Care and Treatment for TB and HIV, South African Medical Research Council. Johannesburg, South Africa;

6. 6Johns Hopkins University School of Medicine, Baltimore, Maryland;

7. 7Foundation for Professional Development, Pretoria, South Africa;

8. 8North Bristol NHS Trust, Bristol, United Kingdom;

9. 9Africa Health Research Institute, School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Abstract

ABSTRACT. Tuberculosis (TB) remains the leading cause of hospitalization and in-hospital mortality in HIV-positive adults. Using data from hospital and clinic files, research databases, and autopsy, we describe causes and outcomes of admissions, and assess investigations for TB among adults with advanced HIV who were hospitalized after enrollment into the TB Fast Track trial in South Africa (2013–2015). A total of 251 adults [median CD4 count, 37.5 cells/μL; interquartile range, 14–68 cells/µL; 152 (60.6%) on antiretroviral therapy] experienced 304 admissions. Ninety-five of 251 of the first admissions (37.8%) were TB related; the next most common causes were AIDS-related illnesses (41 of 251, 16.3%) and surgical causes (21 of 251, 8.4%). Of those admitted with previously undiagnosed TB, 60% had CD4 counts less than 50 cells/µL. Overall, 137 of 251 individuals died as inpatients or within 90 days of their first discharge. Case fatality rates were particularly high for those admitted with TB (66%) and bacterial infections (80%). In 144 admissions for whom anti-TB treatment had not been started before admission, a sputum-based TB investigation was recorded in only 12 of 57 admissions (21.1%) in whom one or more TB symptom was recorded (24 of 57 started on treatment), and 6 of 87 admissions (6.9%) in whom no TB symptoms were recorded (14 of 87 started on treatment). Hospitalized adults with advanced HIV are at high risk of death. TB was a common cause of hospitalization but was under-investigated, even in those with symptoms. In addition to early identification of TB and other AIDS-related illnesses during hospitalization of adults with advanced HIV, improved pre-hospital management strategies are needed to interrupt disease progression and reduce poor outcomes in this already vulnerable population.

Publisher

American Society of Tropical Medicine and Hygiene

Subject

Virology,Infectious Diseases,Parasitology

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