Case-fatality is the percentage of TB patients who die within a given period (e.g. during treatment). HIV-positive TB patients have a much higher case-fatality during and after anti-TB treatment compared with HIV-negative patients. In sub-Saharan Africa, up to 30% of HIV-positive smear-positive PTB patients die before the end of treatment. Evidence is also accumulating that HIV-positive smear-negative PTB patients have a worse prognosis than those who have HIV-positive smear-positive PTB. Excess deaths in TB/HIV patients during and after treatment are partly due to TB itself and partly due to other HIV-related problems. These include septicaemia, diarrhoea, pneumonia, anaemia, Kaposi sarcoma, and cryptococcal meningitis.
Case-fatality is lower in TB/HIV patients treated with SCC than with the old standard regimen (ISHT or SHE/IIHT or HE).This is partly because SCC is a more effective anti-TB treatment. Also, as well as anti-TB activity, rifampicin has broad-spectrum antimicrobial activity. This may reduce deaths due to HIV-related bacterial infections during TB treatment.
Two studies suggest the importance of DOT in reducing deaths. Self-administered treatment was associated with a higher mortality among HIV-positive TB patients compared with DOT. This association remained even after controlling for all other factors in a multivariate analysis. Adjunctive treatments may be needed with anti-TB treatment to reduce deaths.
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