Clinical outcomes and mortality associated factors in patients infected with HIV receiving a presumptive anti-tuberculosis treatment in a tertiary level hospital in Burkina Faso

AIDS Care. 2015;27(10):1250-4. doi: 10.1080/09540121.2015.1050982. Epub 2015 Aug 20.


Introduction: Tuberculosis is the leading cause of death among people living with HIV/AIDS (PLHIV) in sub-Saharan Africa. In PLHIV, Smear-Negative Pulmonary Tuberculosis (SNPTB) and Extrapulmonary Tuberculosis (EPTB) are predominant. Presumptive anti-tuberculosis (anti-TB) treatment is often delayed leading to a high mortality rate.

Objectives: To investigate the clinical outcomes of presumptive anti-TB treatment in HIV patients suspected of having TB and to determine the factors associated with patients' death.

Methods: We conducted a retrospective descriptive study from 1 January 2007 to 31 December 2008 in the Department of Internal Medicine of the Hospital Yalgado Ouédraogo on patients infected with HIV who received a presumptive anti-TB treatment. Defining patients with SNPTB or EPTB was based on the 2007 WHO's diagnostic algorithm of SNPTB and EPTB.

Results: One hundred and sixteen patients of the 383 (30.2%) HIV patients hospitalized in this period were suspected of having TB. The average CD4 count was 86.1 cells/µl (SD = 42.3). A SNPTB was diagnosed in 67 patients (57.8%) and a EPTB in 49 patients (42.2%). The median length of hospitalization duration was 23.5 days. The average time of initiation of anti-TB treatment after admission was 22 days (SD = 9.2 days). Evolution during the hospital stay was favorable for 65 patients (56.0%), unfavorable for 48 patients (41.4% or 12.5% of all hospitalized patients), and 3 patients (2.6%) were treatment defaulters. In a multivariate analysis, hospitalization duration longer than 15 days and a delay of anti-TB treatment initiation of more than 30 days are independent factors associated with patients' deaths.

Conclusion: An urgent access to TB-diagnostic tools and a revision of the International algorithm for the diagnosis and treatment of SNPTB and EPTB in the context of HIV could help to reduce the delay of anti-TB treatment initiation and the mortality rate of PLHIV in sub-Saharan Africa.

Keywords: HIV-TB co-infection; Smear-Negative Pulmonary TB; extrapulmonary TB; presumptive treatment.

MeSH terms

  • Adult
  • Aged
  • Antitubercular Agents / administration & dosage
  • Antitubercular Agents / therapeutic use*
  • Burkina Faso / epidemiology
  • CD4 Lymphocyte Count
  • Drug Administration Schedule
  • Female
  • HIV Infections*
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Retrospective Studies
  • Tertiary Care Centers
  • Tuberculosis, Pulmonary / complications
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / mortality*
  • Young Adult


  • Antitubercular Agents