HIV-associated TB mortality and blocks in the cascade Dr Nathan Ford, MPH, PHD, FRCPE Dept HIV & Global Hepatitis Programme World Health Organization

Late presentation: a persistent challenge World Health Organization 15 September 2018 Late presentation: a persistent challenge CD4 at start of ART Advanced disease at enrolment (CD4 <350) 306 CD4 among people starting ART is rising, but still remains low overall, with many people still starting ART at CD4 less than 200. There are also many losses between diagnosis and start of ART. 167 IeDEA-WHO Collaboration 2015

TB is the leading cause of hospitalization 30% diagnosed with HIV at time of admission Median CD4: 131 No change over time Ford et al, JIAS 2016

Ford et al Lancet HIV 2015

Gupta et al, AIDS 2015

TB was a cause of 5% - 44% early mortality in Sub-Saharan Africa Early mortality rates are highest at Sub-Sharan Africa at 17& Most common causes of death reported were TB accounting for 5%–44% of deaths

Advanced disease ≠ late presenters N= 609 HIV-positive admissions ART status : naïve: 35.7% current:45.0% interrupted :19.3% Most frequent primary clinical diagnoses: TB ( 33.5%) Other bacterial infection (17.1%) Other AIDS-defining illnesses ( 10.9%) By 90 days follow-up, 29.9% required readmission and 13.3% died Commonest causes of death: TB (37.2%) Meintjes G et al Medicine 2015 (Slide courtesy of Eric Goemaere)

Case fatality during TB treatment by HIV status (2013 cohort) 11% 3.5% WHO Global Tuberculosis Report, 2015

No significant difference in death and default rates between HIV-positive TB patients on ART and HIV negative TB patients Died ART vs No ART = aOR 7.4 Nglazi et al, BMC ID 2015

Cascade of diagnosis and treatment of HIV in TB cases, 2013 48% 67% Lessells RJ, Swaminathan S, Godfrey-Faussett P. Current Opinions 2015

World Health Organization Acknowledgements 15 September 2018 Annabel Baddeley Meg Doherty Haileyesus Getahun Eric Goemaere CD4 among people starting ART is rising, but still remains low overall, with many people still starting ART at CD4 less than 200. There are also many losses between diagnosis and start of ART.