Low mortality rates at two years in HIV-infected individuals undergoing systematic tuberculosis testing with rapid assays at initiation of antiretroviral treatment in Mozambique

Abstract Background Few studies have evaluated the mortality rate in individuals with HIV initiating antiretroviral therapy (ART), undergoing screening with combined or repeated rapid tests for tuberculosis (TB). Methods All individuals with HIV starting ART, irrespective of presence of TB-related symptoms, received two consecutive Xpert tests plus a rapid test for detection of mycobacterial lipoarabinomannan in urine (LAM). Mortality was evaluated in Kaplan-Meier analyses using the log-rank test in univariate analyses and Cox regression models with time-dependent covariates in multivariate analyses. Results Among 972 individuals screened with combined tests, 98 (10.1%) tested positive for TB with Xpert, LAM, or both. At the end of the study, 780 (80.2%) had completed two years of follow up, 39 (4.0%) had deceased, and 153 (15.7%) were lost to follow up. In multivariate analyses, the factors significantly associated with mortality were missed ART (hazard ratio [HR]: 7.05, 95%CI 2.33-21.35), symptomatic (WHO-HIV stage >1) HIV disease (HR 3.31, 95%CI 1.28-8.54), and low ( Conclusions We observed a low mortality rate among individuals with HIV undergoing systematic testing for TB at initiation of ART. After adjusting for confounders, mortality was significantly associated with missed ART, advanced disease, and missed anti-TB treatment. These findings reinforce the need to promote early diagnosis of HIV and the adoption of screening strategies for TB that prevent presentation with severe disease.