Tuberculosis as a cause of death in HIV + patients in Africa: autopsy Autopsies on 108 HIV+ patients in Botswana (selected) Cause of death: Tuberculosis37% Pneumonia14% Pneumocystis11% Kaposi’s sarcoma 7% Cryptococcosis 6% Other 25% - Ansari (Int J Tuberc 2002)

Pre-mortem or initial diagnosis in patients with disseminated TB Diagnosis Fatal cases Non-fatal cases (n=15)(n=5) Pre-mort Dx Initial Dx Pulmonary TB24 Extrapulm TB42 AIDS3 Malaria 6 PCP or pn7 Other4 - Kimambo et al, Capetown Intl TB, Nov 07

Disseminated TB cases (n=19) Treatment and outcome Death: 17 (89%) of 19 Survival: 3d – 18 mos (median 30d, mean 87d) Positive TB lab before death: 4 (21%) of 19 TB Rx before death: 7 (37%) of 19 2 survivors had TB Rx within 2 weeks of blood culture 5 fatal cases lived 1d, 2 wks, 2 mos, 5 mos, 8 mos

CD4 and TB microbiology Progressive fall in CD4 needs to be monitored for starting ART TB is most common cause of death from HIV – prompt and accurate reports from lab essential to reducing mortality.

Bakari:CD4 count and TB tests CD4 count results: –Affirming a diagnosis of Immunosuppression –Initiation of ART –Assessment of response to ARV –Diagnosis of IRIS TB test results: –Initiation of ART if has CD4 of cells/µl –Choice of ART regimen –Diagnosis of IRIS –Anti TB resistance

Mtei: Research setting test needed to answer research question concerning disease presence & classify disease as per research protocol (also for management) time of test results should be as per protocol since research schedule has to be adhered to inaccurate results give wrong research outcome; cannot answer research question; cannot contribute to science late results give inappropriate research conclusion; delays answer of research question; delays writing of reports; cause financial constraints