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

2. 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

3. 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

4. Ford et al Lancet HIV 2015

5. Gupta et al, AIDS 2015

6. 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

7. 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)

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

9. 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

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

11. 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.