Trends in mortality from pulmonary tuberculosis and HIV/AIDS co-infection in rural South Africa (Agincourt)

This study investigates trends and age-and-sex patterns of mortality in pulmonary tuberculosis (PTB) and PTB/HIV co-infection in a rural population of South Africa. The PTB/HIV mortality emerged in 1994, and has been rising ever since (men: P=0.001; women: P=0.020, test for trend). In the last 2 years, for both sexes combined, 63% (95% Cl 51-74%) of PTB deaths were attributable to HIV/AIDS. PTB/HIV death rate was higher in men than in women for all ages combined (RRMH =2.48, 95% Cl 1.53-4.04, P < 0.001). PTB/HIV death rate was also higher younger individuals (< 25 years) compared with PTB without HIV/AIDS (P= 0.033), and the median age at death from PTB/HIV in women (28 years) was lower than in men (38 years, P=0.002). While mortality from PTB without HIV remained constant over time, HIV/AIDS explained the rise in PTB mortality. In the last 3 years, the HlV/AlDS epidemic has caused the number of persons dying of PTB to increase by +117%, with the mortality excess being higher in women (+164%) than in men (+103%, P=0.001). Combined PTB and HIV programme activities need to be reinforced to respond to the increase in PTB mortality, particularly in women. (c) 2007 Royal Society of Tropical. Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.