Mortality associated with tuberculosis/HIV co-infection among patients on TB treatment in the Limpopo province, South Africa.

Background: South Africa has a high tuberculosis burden, and Limpopo Province experienced higher than national average TB mortality rates between 1997 and 2008.
Objective: To establish factors associated with TB mortality in Limpopo Province in 2008.
Design: Retrospective study using provincial data for patients who died after commencing TB treatment between 01 January 2008 and 31 December 2008.
Results: In 2008, some 18074 patients started treatment: 15995 (88.5%) had pulmonary TB (PTB), while 2079 (11.5%) had Extra pulmonary TB (EPTB). Overall, 2242 (12.4%) patients died, mainly PTB patients (n=1906;85%),more males (n=1159,51.7%), mainly those aged 25 to 54 years (n=1749, 78.0%), and new cases (1914;85.4%). TB mortality was significantly higher among smear negative than smear positive patients (17% vs 13.8%; P<0.001), among those with EPTB compared to PTB patients (P<0.001), and among re-treatment cases (P<0.001). Only 4237(23.4%) patients had HIV status known, with higher mortality found among HIV positive than the HIV negative patients (P<0.0001); but HIV status was not known for the majority who died (n=1685, 75.2%).
Conclusion: Higher mortality was associated with age 22-55 years; smear negativity, EPTB, HIV infection, and re-treatment. The findings call for greater integration of TB control efforts and HIV services, especially among the 22-55 year age group.